## 4 Discussion
Additionally, AI-driven technologies have the potential to democratize access to specialized diagnostic capabilities, improve the quality and efficiency of care, expand global access to healthcare, and enhance both the speed and quality of treatment [23]. A limitation of the study is the lack of a separate analysis of the time-saving effect at each GMFCS level due to the small dataset. Given the known variability in motor function across GMFCS classifications, a subgroup analysis would have provided valuable additional insights into the applicability of the rGMFM-66 across different functional profiles. Such analyses were not feasible in the present study due to the limited sample size but are strongly recommended for future research. Additionally, due to the study design, the determination of GMFM-66 and rGMFM-66 were two separate examinations on different days. This study design limits the evaluation of the agreement between GMFM-66 and rGMFM-66. However, in a previous retrospective analysis, the agreement between the two methods was already analyzed in a significantly larger study group [13]. Furthermore, individual fluctuations in muscle tone, particularly spasticity, and passive range of motion both of which may vary throughout the day could have influenced the children's performance on specific GMFM-66 items. Although regular neuro-orthopedic assessments were part of the rehabilitation program, these clinical parameters were not systematically recorded for analysis. Another limitation of this study may be the potential influence of therapeutic interventions such as whole-body vibration (WBV), which was part of the standardized rehabilitation program. WBV has been associated with improvements in lower extremity function in children with cerebral palsy, potentially influencing GMFM-66 performance [24]. Although WBV was not performed immediately prior to GMFM assessments in this study, a residual training effect cannot be entirely ruled out and should be considered when interpreting the results [24; 25]. However, the time interval between assessments was short (1-2 days), and no therapeutic sessions were scheduled immediately prior to the GMFM assessments. Future research should include such factors, as they may impact the reproducibility of motor performance assessments. To address this limitation in future research, alternative study designs should be considered. While same-day testing may not be ethically feasible in pediatric rehabilitation due to fatigue and burden on children, future studies could implement a randomized or counterbalanced design in which the order of test administration is varied across participants. This would allow potential order or learning effects to be statistically controlled, thereby improving the robustness of agreement analyses. Additionally, it is important to note that the majority of participants in this study were diagnosed with spastic cerebral palsy, primarily bilateral spastic forms. This reflects the clinical population typically enrolled in pediatric neurorehabilitation programs and reinforces the relevance of the rGMFM-66 for widespread clinical application in this subgroup [26]. Since the study sample consisted predominantly of children with spastic cerebral palsy, the generalizability of the findings to other CP subtypes such as dyskinetic or ataxic forms is limited. Although the spastic subtype represents the most common form, accounting for approximately 70-80% of all cases [14], future studies are needed to validate the applicability of the rGMFM-66 in non-spastic populations. Furthermore, a potential learning effect may have influenced the results, as the children had already become familiar with the test items during the first assessment. This familiarity might have enabled them to perform the tasks more quickly during the second examination. However, given the considerable time savings observed in the rGMFM-66, it is unlikely that this learning effect was the primary factor responsible for the reduced duration.