{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T23:26:37Z","timestamp":1785540397752,"version":"3.56.0"},"reference-count":67,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2025,1,30]],"date-time":"2025-01-30T00:00:00Z","timestamp":1738195200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: There is high-level research evidence supporting task-focused upper limb therapy models for children with unilateral cerebral palsy (CP). However, a knowledge gap exists in understanding how to effectively implement distributed practice approaches in clinical practice and the effect on the development of bimanual performance. This study aims to evaluate clinical outcomes, examine key considerations for implementation outcomes, and propose a Model of Care for children with unilateral CP. Methods: A mixed-methods approach was applied, including a retrospective case series with an observational descriptive design. A convenience sample of nine children (&lt;5 years of age) with unilateral CP who received multiple blocks of distributed, evidence-based upper limb therapy approaches between 2014 and 2020 were included. Outcomes were evaluated using the Assisting Hand Assessment family of assessments. A Model of Care framework was informed by the Updated Consolidated Framework for Implementation Research and the Conceptual Model for Implementation Research. Results: A total of 59 blocks of upper limb therapy (10 mCIMT and 49 bimanual therapy) were delivered, ranging from two to nine blocks (mean = 6.6) for each child. All children demonstrated improved outcomes in bimanual performance with an average change of 14 AHA units (range 1\u201322). Barriers to implementation included complexity and cost. Facilitators included the evidence base and adaptability of the approaches that allowed clinicians to respond to an individual child and family\u2019s needs. Informed by evidence-based protocols and visual analysis of data, and in consideration of the barriers and\/or facilitators to implementation from this study, a Model of Care for implementation of upper limb distributed practice approaches for children with unilateral CP in clinical practice is proposed. Conclusions: Implementing repeated, distributed blocks of evidence-based upper limb therapy in a clinical setting for children with unilateral CP led to incremental improvements in bimanual performance. There are a range of barriers and facilitators to the implementation of distributed practice approaches in clinical practice. The Model of Care outlines best practice care and service delivery for children with unilateral CP and their families and aims to support clinical practice and the future examination of implementation-effectiveness in practice.<\/jats:p>","DOI":"10.3390\/jcm14030924","type":"journal-article","created":{"date-parts":[[2025,1,30]],"date-time":"2025-01-30T11:42:37Z","timestamp":1738237357000},"page":"924","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Barriers, Facilitators, and a Proposed Model of Care for Implementation of Upper Limb Distributed Practice Approaches for Children with Unilateral Cerebral Palsy"],"prefix":"10.3390","volume":"14","author":[{"given":"Emma","family":"Taylor","sequence":"first","affiliation":[{"name":"Cerebral Palsy Group, 74 Faraday Street, Carlton, VIC 3053, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-1128-661X","authenticated-orcid":false,"given":"Susan","family":"Greaves","sequence":"additional","affiliation":[{"name":"Cerebral Palsy Group, 74 Faraday Street, Carlton, VIC 3053, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5106-4141","authenticated-orcid":false,"given":"Brian","family":"Hoare","sequence":"additional","affiliation":[{"name":"Cerebral Palsy Group, 74 Faraday Street, Carlton, VIC 3053, Australia"},{"name":"School of Allied Health, Australian Catholic University, 115 Victoria Parade, Fitzroy, VIC 3065, Australia"},{"name":"Discipline of Occupational Therapy, La Trobe University, Plenty Road, Bundoora, VIC 3086, Australia"},{"name":"Department of Paediatrics, Monash University, Clayton VIC 3800, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,1,30]]},"reference":[{"key":"ref_1","unstructured":"(2024, December 14). Report of the Australian Cerebral Palsy Register, Birth Years 1995\u20132016, January 2023. Available online: https:\/\/cpregister.com\/wp-content\/uploads\/2023\/01\/2023-ACPR-Report.pdf."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"949","DOI":"10.1177\/08830738221124365","article-title":"Upper Limb Onabotulinumtoxin A Injections in Children Under 2 Years with Cerebral Palsy: A Retrospective Chart Review","volume":"37","author":"Centorame","year":"2022","journal-title":"J. Child Neurol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1042","DOI":"10.1111\/dmcn.13106","article-title":"Longitudinal Development of Hand Function in Children with Unilateral Spastic Cerebral Palsy Aged 18 Months to 12 Years","volume":"58","author":"Nordstrand","year":"2016","journal-title":"Dev. Med. Child Neurol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1462","DOI":"10.1111\/dmcn.14957","article-title":"Hand Use Development in Children with Unilateral Cerebral Palsy","volume":"63","author":"Klevberg","year":"2021","journal-title":"Dev. Med. Child Neurol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"352","DOI":"10.1111\/j.1469-8749.2009.03364.x","article-title":"Longitudinal Development of Hand Function in Children with Unilateral Cerebral Palsy","volume":"52","author":"Holmefur","year":"2010","journal-title":"Dev. Med. Child Neurol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1177\/1545968312446950","article-title":"Neuroradiology Can Predict the Development of Hand Function in Children with Unilateral Cerebral Palsy","volume":"27","author":"Holmefur","year":"2013","journal-title":"Neurorehabilit. Neural Repair"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Sakzewski, L., Greaves, S., Eliasson, A.C., Wallen, M., Novak, I., Ware, R.S., Heathcock, J., Maitre, N., and Boyd, R. (Dev. Med. Child Neurol., 2025). Early developmental trajectories of the impaired hand in infants with unilateral cerebral palsy, Dev. Med. Child Neurol., early view.","DOI":"10.1111\/dmcn.16240"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Friel, K.M., Williams, P.T.J.A., Serradj, N., Chakrabarty, S., and Martin, J.H. (2014). Activity-Based Therapies for Repair of the Corticospinal System Injured during Development. Front. Neurol., 5.","DOI":"10.3389\/fneur.2014.00229"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"S225","DOI":"10.1044\/1092-4388(2008\/018)","article-title":"Principles of Experience-Dependent Neural Plasticity: Implications for Rehabilitation After Brain Damage","volume":"51","author":"Kleim","year":"2008","journal-title":"J. Speech Lang. Hear. Res."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1111\/dmcn.14252","article-title":"International Expert Recommendations of Clinical Features to Prompt Referral for Diagnostic Assessment of Cerebral Palsy","volume":"62","author":"Boychuck","year":"2020","journal-title":"Dev. Med. Child Neurol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"490","DOI":"10.1111\/dmcn.13680","article-title":"Development of Bimanual Performance in Young Children with Cerebral Palsy","volume":"60","author":"Klevberg","year":"2018","journal-title":"Dev. Med. Child Neurol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"376","DOI":"10.1111\/dmcn.15370","article-title":"Longitudinal Development of Hand Use in Children with Unilateral Spastic Cerebral Palsy from 18 Months to 18 Years","volume":"65","author":"Eliasson","year":"2023","journal-title":"Dev. Med. Child Neurol."},{"key":"ref_13","first-page":"47","article-title":"Unimanual versus Bimanual Therapy in Children with Unilateral Cerebral Palsy: Same, Same, but Different","volume":"10","author":"Hoare","year":"2017","journal-title":"J. Pediatr. Rehabil. Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1536","DOI":"10.1080\/09638288.2022.2063414","article-title":"Are They Really Motor Learning Therapies? A Scoping Review of Evidence-Based, Task-Focused Models of Upper Limb Therapy for Children with Unilateral Cerebral Palsy","volume":"45","author":"Taghizadeh","year":"2023","journal-title":"Disabil. Rehabil."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"e175","DOI":"10.1542\/peds.2013-0675","article-title":"Efficacy of Upper Limb Therapies for Unilateral Cerebral Palsy: A Meta-Analysis","volume":"133","author":"Sakzewski","year":"2014","journal-title":"Pediatrics"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"830","DOI":"10.1111\/j.1469-8749.2007.00830.x","article-title":"Efficacy of a Hand\u2013Arm Bimanual Intensive Therapy (HABIT) in Children with Hemiplegic Cerebral Palsy: A Randomized Control Trial","volume":"49","author":"Gordon","year":"2007","journal-title":"Dev. Med. Child Neurol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"238","DOI":"10.1111\/dmcn.12054","article-title":"Intensive Therapy Following Upper Limb Botulinum Toxin A Injection in Young Children with Unilateral Cerebral Palsy: A Randomized Trial","volume":"55","author":"Hoare","year":"2013","journal-title":"Dev. Med. Child Neurol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"2820","DOI":"10.1016\/j.ridd.2011.05.024","article-title":"An Ecological Approach of Constraint Induced Movement Therapy for 2\u20133-Year-Old Children: A Randomized Control Trial","volume":"32","author":"Eliasson","year":"2011","journal-title":"Res. Dev. Disabil."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1091","DOI":"10.1111\/j.1469-8749.2011.04086.x","article-title":"Modified Constraint-induced Therapy for Children with Hemiplegic Cerebral Palsy: A Randomized Trial","volume":"53","author":"Wallen","year":"2011","journal-title":"Dev. Med. Child Neurol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e606","DOI":"10.1542\/peds.2009-0288","article-title":"Occupational Therapy Home Programs for Cerebral Palsy: Double-Blind, Randomized, Controlled Trial","volume":"124","author":"Novak","year":"2009","journal-title":"Pediatrics"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"7206205010p1","DOI":"10.5014\/ajot.2018.025981","article-title":"Effectiveness of Modified Constraint-Induced Movement Therapy Compared with Bimanual Therapy Home Programs for Infants with Hemiplegia: A Randomized Controlled Trial","volume":"72","author":"Chamudot","year":"2018","journal-title":"Am. J. Occup. Ther."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"987","DOI":"10.1037\/0278-7393.23.4.987","article-title":"Variability of Practice and Implicit Motor Learning","volume":"23","author":"Wulf","year":"1997","journal-title":"J. Exp. Psychol. Learn. Mem. Cogn."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1080\/00222890309602119","article-title":"Effect of Practice on Effector Independence","volume":"35","author":"Park","year":"2003","journal-title":"J. Mot. Behav."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"625","DOI":"10.1111\/dmcn.13379","article-title":"Intensive Upper- and Lower-Extremity Training for Children with Bilateral Cerebral Palsy: A Quasi-Randomized Trial","volume":"59","author":"Bleyenheuft","year":"2017","journal-title":"Dev. Med. Child Neurol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1007\/s11910-020-1022-z","article-title":"State of the Evidence Traffic Lights 2019: Systematic Review of Interventions for Preventing and Treating Children with Cerebral Palsy","volume":"20","author":"Novak","year":"2020","journal-title":"Curr. Neurol. Neurosci. Rep."},{"key":"ref_26","first-page":"CD004149","article-title":"Constraint-Induced Movement Therapy in Children with Unilateral Cerebral Palsy","volume":"4","author":"Hoare","year":"2019","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1111\/dmcn.12596","article-title":"Constraint Therapy, the Panacea for Unilateral Cerebral Palsy?","volume":"57","author":"Hoare","year":"2015","journal-title":"Dev. Med. Child Neurol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"365","DOI":"10.3390\/disabilities2020026","article-title":"Improved Hand Function in Children with Cerebral Palsy with Repeat Doses of Group Based Hybrid Pediatric Constraint-Induced Movement Therapy","volume":"2","author":"Roberts","year":"2022","journal-title":"Disabilities"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"6906180010p1","DOI":"10.5014\/ajot.2015.019323","article-title":"Multiple Treatments of Pediatric Constraint-Induced Movement Therapy (PCIMT): A Clinical Cohort Study","volume":"69","author":"Deluca","year":"2015","journal-title":"Am. J. Occup. Ther."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"770","DOI":"10.1111\/j.1469-8749.2007.00770.x","article-title":"A Repeated Course of Constraint-induced Movement Therapy Results in Further Improvement","volume":"49","author":"Charles","year":"2007","journal-title":"Dev. Med. Child Neurol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1016\/j.ridd.2017.11.006","article-title":"The Effectiveness of Baby-CIMT in Infants Younger than 12 Months with Clinical Signs of Unilateral-Cerebral Palsy; an Explorative Study with Randomized Design","volume":"72","author":"Eliasson","year":"2018","journal-title":"Res. Dev. Disabil."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1080\/17518423.2023.2193256","article-title":"Development of Hand Use with and Without Intensive Training Among Children with Unilateral Cerebral Palsy in Scandinavia","volume":"26","author":"Klevberg","year":"2023","journal-title":"Dev. Neurorehabilit."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"885","DOI":"10.1111\/dmcn.12246","article-title":"A Systematic Review of Interventions for Children with Cerebral Palsy: State of the Evidence","volume":"55","author":"Novak","year":"2013","journal-title":"Dev. Med. Child Neurol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"163","DOI":"10.3109\/01942638.2013.757157","article-title":"Six Years After a Modified Constraint Induced Movement Therapy (CIMT) Program-What Happens When the Children Have Become Young Adults?","volume":"33","author":"Nordstrand","year":"2013","journal-title":"Phys. Occup. Ther. Pediatr."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1136\/emj.20.1.54","article-title":"Observational research methods. Research design II: Cohort, cross sectional, and case-control studies","volume":"20","author":"Mann","year":"2003","journal-title":"Emerg. Med. J."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1016\/j.jphys.2022.05.009","article-title":"Research Note: Designing Implementation Trials in Physiotherapy","volume":"68","author":"Hassett","year":"2022","journal-title":"J. Physiother."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"549","DOI":"10.1017\/S0012162206001162","article-title":"The Manual Ability Classification System (MACS) for Children with Cerebral Palsy: Scale Development and Evidence of Validity and Reliability","volume":"48","author":"Eliasson","year":"2006","journal-title":"Dev. Med. Child Neurol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1276","DOI":"10.1111\/dmcn.13585","article-title":"Development of the Hand Assessment for Infants: Evidence of Internal Scale Validity","volume":"59","author":"Ek","year":"2017","journal-title":"Dev. Med. Child Neurol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1030","DOI":"10.1111\/dmcn.12212","article-title":"Development of the Mini-Assisting Hand Assessment: Evidence for Content and Internal Scale Validity","volume":"55","author":"Greaves","year":"2013","journal-title":"Dev. Med. Child Neurol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"618","DOI":"10.1111\/dmcn.12939","article-title":"Psychometric Properties of a Revised Version of the Assisting Hand Assessment (Kids-AHA 5.0)","volume":"58","author":"Holmefur","year":"2016","journal-title":"Dev. Med. Child Neurol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1186\/s13012-022-01245-0","article-title":"The Updated Consolidated Framework for Implementation Research Based on User Feedback","volume":"17","author":"Damschroder","year":"2022","journal-title":"Implement. Sci."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1007\/s10488-008-0197-4","article-title":"Implementation Research in Mental Health Services: An Emerging Science with Conceptual, Methodological, and Training Challenges","volume":"36","author":"Proctor","year":"2009","journal-title":"Adm. Policy Ment. Health Ment. Health Serv. Res."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1186\/s13012-015-0295-0","article-title":"Use of Concept Mapping to Characterize Relationships among Implementation Strategies and Assess Their Feasibility and Importance: Results from the Expert Recommendations for Implementing Change (ERIC) Study","volume":"10","author":"Waltz","year":"2015","journal-title":"Implement. Sci."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"e084320","DOI":"10.1136\/bmjopen-2024-084320","article-title":"Enhancing the Reporting Quality of Rehabilitation Interventions through an Extension of the Template for Intervention Description and Replication (TIDieR): The TIDieR-Rehab Checklist and Supplementary Manual","volume":"14","author":"Signal","year":"2024","journal-title":"BMJ Open"},{"key":"ref_45","unstructured":"Agency for Clinical Innovation, Implementation Team, Clinical Redesign and Implementation Portfolio (2024, May 22). ACI (2013). Understanding the Process to Implement a Model of Care\u2014An ACI Framework. Agency for Clinical Innovation, Available online: https:\/\/www.aci.health.nsw.gov.au\/__data\/assets\/pdf_file\/0009\/194715\/HS13-036_ImplementationFramework_D5-ck2.pdf."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"47","DOI":"10.37464\/2006.233.1935","article-title":"Beyond the Rhetoric: What Do We Mean by a \u201cModel of Care\u201d?","volume":"23","author":"Davidson","year":"2006","journal-title":"Aust. J. Adv. Nurs."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"S69","DOI":"10.1097\/CCM.0b013e3181920e33","article-title":"The Design and Interpretation of Pilot Trials in Clinical Research in Critical Care","volume":"37","author":"Arnold","year":"2009","journal-title":"Crit. Care Med."},{"key":"ref_48","unstructured":"(2024, December 18). CPToys.org. Available online: https:\/\/www.cptoys.org."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1007\/s10488-010-0319-7","article-title":"Outcomes for Implementation Research: Conceptual Distinctions, Measurement Challenges, and Research Agenda","volume":"38","author":"Proctor","year":"2011","journal-title":"Adm. Policy Ment. Health Ment. Health Serv. Res."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"457","DOI":"10.1111\/j.1365-2214.2011.01338.x","article-title":"The \u2018F-words\u2019 in childhood disability: I swear this is how we should think!","volume":"38","author":"Rosenbaum","year":"2012","journal-title":"Child Care Health Dev."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"498","DOI":"10.1111\/dmcn.12706","article-title":"What Can Be Learned from Reporting No-treatment Effect of Distribution of Upper Limb Training?","volume":"57","author":"Eliasson","year":"2015","journal-title":"Dev. Med. Child Neurol."},{"key":"ref_52","doi-asserted-by":"crossref","unstructured":"Greaves, S., and Hoare, B. (2024). Upper Limb Therapy for Infants and Young Children with Unilateral Cerebral Palsy: A Clinical Framework. J. Clin. Med., 13.","DOI":"10.3390\/jcm13226873"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"846","DOI":"10.1001\/jamapediatrics.2021.0878","article-title":"Early Intervention for Children Aged 0 to 2 Years with or at High Risk of Cerebral Palsy: International Clinical Practice Guideline Based on Systematic Reviews","volume":"175","author":"Morgan","year":"2021","journal-title":"JAMA Pediatr."},{"key":"ref_54","unstructured":"National Disability Insurance Agency (2024, December 16). \u201cWhat Is the NDIS?\u201d, Available online: https:\/\/www.ndis.gov.au\/understanding\/what-ndis."},{"key":"ref_55","first-page":"100","article-title":"What Is \u201cCoaching\u201d? An Exploration of Conflicting Paradigms","volume":"6","author":"Ives","year":"2008","journal-title":"Int. J. Evid. Based Coach. Mentor."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1300\/J006v24n01_04","article-title":"Activity-Focused Motor Interventions for Children with Neurological Conditions","volume":"24","author":"Valvano","year":"2004","journal-title":"Phys. Occup. Ther. Pediatr."},{"key":"ref_57","doi-asserted-by":"crossref","unstructured":"Morgan, C., Novak, I., Dale, R.C., and Badawi, N. (2015). Optimising Motor Learning in Infants at High Risk of Cerebral Palsy: A Pilot Study. BMC Pediatr., 15.","DOI":"10.1186\/s12887-015-0347-2"},{"key":"ref_58","doi-asserted-by":"crossref","unstructured":"Hoare, B.J., Imms, C., Rawicki, H.B., and Carey, L. (2010). Modified Constraint-Induced Movement Therapy or Bimanual Occupational Therapy Following Injection of Botulinum Toxin-A to Improve Bimanual Performance in Young Children with Hemiplegic Cerebral Palsy: A Randomised Controlled Trial Methods Paper. BMC Neurol., 10.","DOI":"10.1186\/1471-2377-10-58"},{"key":"ref_59","doi-asserted-by":"crossref","unstructured":"Eliasson, A.-C., Sj\u00f6strand, L., Ek, L., Krumlinde-Sundholm, L., and Tedroff, K. (2014). Efficacy of Baby-CIMT: Study Protocol for a Randomised Controlled Trial on Infants below Age 12 Months, with Clinical Signs of Unilateral CP. BMC Pediatr., 14.","DOI":"10.1186\/1471-2431-14-141"},{"key":"ref_60","first-page":"49","article-title":"Learning to Learn: Mediated Learning Experiences and Instrumental Enrichment","volume":"3","author":"Feuerstein","year":"1986","journal-title":"Spec. Serv. Sch."},{"key":"ref_61","first-page":"401","article-title":"Motor Skill Acquisition Frame of Reference","volume":"Volume 2","author":"Hinojosa","year":"1999","journal-title":"Frames of Reference for Pediatric Occupational Therapy"},{"key":"ref_62","unstructured":"Meichenbaum, D. (1979). Cognitive-Behavior Modification, an Integrative Approach, Springer Science + Business Media, LLC. [2nd ed.]."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1146\/annurev.ps.39.020188.000245","article-title":"Exploratory Behavior in the Development of Perceiving, Acting, and the Acquiring of Knowledge","volume":"39","author":"Gibson","year":"1988","journal-title":"Annu. Rev. Psychol."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1177\/0269215506073494","article-title":"Goal-Directed Training: Linking Theories of Treatment to Clinical Practice for Improved Functional Activities in Daily Life","volume":"21","author":"Mastos","year":"2007","journal-title":"Clin. Rehabil."},{"key":"ref_65","doi-asserted-by":"crossref","unstructured":"Thelen, E., and Smith, L.B. (1994). Dynamic Systems: Exploring Paradigms for Change. A Dynamic Systems Approach to the Development of Cognition and Action, MIT Press.","DOI":"10.7551\/mitpress\/2524.001.0001"},{"key":"ref_66","doi-asserted-by":"crossref","unstructured":"Law, M. (1998). Family-Centred Functional Therapy for Children with Cerebral Palsy: An Emerging Practice Model, Taylor & Francis Group.","DOI":"10.1080\/J006v18n01_06"},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"5624","DOI":"10.1080\/09638288.2024.2307382","article-title":"Development and Content Validation of the Upper Limb-Motor Learning Strategy Tool for Cerebral Palsy","volume":"46","author":"Taghizadeh","year":"2024","journal-title":"Disabil. Rehabil."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/3\/924\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T16:24:31Z","timestamp":1760027071000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/3\/924"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,30]]},"references-count":67,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2025,2]]}},"alternative-id":["jcm14030924"],"URL":"https:\/\/doi.org\/10.3390\/jcm14030924","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1,30]]}}}