Management of cerebral palsy

Researchers are developing an electrical stimulation device specifically designed for children with cerebral palsy, who have foot drop which results in tripping when walking.

Over time, the approach to cerebral palsy management has shifted away from narrow attempts to fix individual physical problems – such as spasticity in a particular limb – to making such treatments part of a larger goal of maximizing the person's independence and community engagement.[1]: 886  Much of childhood therapy is aimed at improving gait and walking. Approximately 60% of people with CP are able to walk independently or with aids at adulthood.[2] However, the evidence base for the effectiveness of intervention programs reflecting the philosophy of independence has not yet caught up: effective interventions for body structures and functions have a strong evidence base, but evidence is lacking for effective interventions targeted toward participation, environment, or personal factors.[1] There is also no good evidence to show that an intervention that is effective at the body-specific level will result in an improvement at the activity level, or vice versa.[1] Although such cross-over benefit might happen, not enough high-quality studies have been done to demonstrate it.[1]

Because cerebral palsy has "varying severity and complexity" across the lifespan,[3] it can be considered a collection of conditions for management purposes.[4] A multidisciplinary approach for cerebral palsy management is recommended,[3] focusing on "maximising individual function, choice and independence" in line with the International Classification of Functioning, Disability and Health's goals.[5] The team may include a paediatrician, a health visitor, a social worker, a physiotherapist, an orthotist, a speech and language therapist, an occupational therapist, a teacher specialising in helping children with visual impairment, an educational psychologist, an orthopaedic surgeon, a neurologist and a neurosurgeon.[6]

Various forms of therapy are available to people living with cerebral palsy as well as caregivers and parents. Treatment may include one or more of the following: physical therapy; occupational therapy; speech therapy; water therapy; drugs to control seizures, alleviate pain, or relax muscle spasms (e.g. benzodiazepines); surgery to correct anatomical abnormalities or release tight muscles; braces and other orthotic devices; rolling walkers; and communication aids such as computers with attached voice synthesisers. A Cochrane review published in 2004 found a trend toward benefit of speech and language therapy for children with cerebral palsy, but noted the need for high quality research.[7] A 2013 systematic review found that many of the therapies used to treat CP have no good evidence base; the treatments with the best evidence are medications (anticonvulsants, botulinum toxin, bisphosphonates, diazepam), therapy (bimanual training, casting, constraint-induced movement therapy, context-focused therapy, fitness training, goal-directed training, hip surveillance, home programmes, occupational therapy after botulinum toxin, pressure care) and surgery (selective dorsal rhizotomy).[1]

Lifestyle

Physical therapy used to treat spastic hemiplegia.

Physical activity is recommended for people with cerebral palsy, particularly in terms of cardiorespiratory endurance, muscle strengthening and reduction of sedentary behaviour. Participating in physical activity can supplement or replace some forms of therapy.[8] It has been argued that people with cerebral palsy need to maintain a higher level of fitness than the general population to offset loss of functionality as they age.[9] Access to exercise can often depend on the caregivers' perception of whether it will benefit the person with CP.[10] There has been increasing interest in maintaining muscle strength through the lifespan of a person with CP.[11] Aerobic capacity is not routinely assessed in people with cerebral palsy in a rehabilitation context, but Wingate tests have been advocated for use.[12] Behavioural change methods have been used to promote physical activity among young people with cerebral palsy, but there is no significant evidence for these working.[13] It is difficult to sustain behavioural change in terms of increasing physical activity of children with CP.[14] Even though exercise is commonly recommended, there is only a small amount of evidence saying that aerobic exercise is good for gross motor function in children.[15] Exercise can increase wellness in those with cerebral palsy. With regards to sports, the amount of exercise advised should be unique to the demands of the sport in question, the effect of the individual's condition on performance, and the potential to cause worsening of the condition. It is recommended, to encourage integrating moderate to vigorous exercise, including the use of a motor-assisted elliptical trainer. This is thought to improve fitness and the functioning.[16]

Function gait training in children and young adults with cerebral palsy improves their ability to walk.[17] There is evidence that antigravity treadmill training may improve the gait and balance of those children with diplegic cerebral palsy, it may also reduce risk of falls in these children.[18]

A normal vaccination schedule should be adhered to, as preventable diseases may take away energy that a person with CP would normally use in day-to-day life.[19]

Therapy

Physiotherapy (also known as physical therapy) programs are designed to encourage the patient to build a strength base for improved gait and volitional movement, together with stretching programs to limit contractures.[20] Physiotherapists can teach parents how to position and handle their child for activities of daily living.[21] The need for lifelong physiotherapy for muscle tone, bone structure and preventing joint dislocation has been debated in terms of the costs and benefits of such therapy.[20] Children may find long-term physical therapy boring.[22] Physiotherapy exercises are designed to improve balance, postural control, gait, and assist with mobility and transferring the person with CP, for example from a wheelchair to a bed.[23]

Speech therapy helps control the muscles of the mouth and jaw, and helps improve communication. Just as CP can affect the way a person moves their arms and legs, it can also affect the way they move their mouth, face and head. This can make it hard for the person to breathe; talk clearly; and bite, chew and swallow food. Speech therapy often starts before a child begins school and continues throughout the school years.[24]

Biofeedback is a therapy in which people learn how to control their affected muscles. Biofeedback therapy has been found to significantly improve gait in children with cerebral palsy.[25] Mirror therapy has been used to improve hand function and was found to be "generally effective in enhancing muscle strength, motor speed, muscle activity, and the accuracy of both hands".[26] Second-generation mirror therapy, which includes the use of robotics or virtual reality, has been developed since the 2000s, however the evidence supporting this is of low quality.[27]

Massage therapy is designed to help relax tense muscles, strengthen muscles, and keep joints flexible.[28]

Gait analysis is often used to describe gait abnormalities in children.[29] Gait training has been shown to improve walking speed in children and young adults with cerebral palsy.[30]

Occupational therapy helps adults and children maximise their function, adapt to their limitations and live as independently as possible.[31][32] A family-centred philosophy is used with children who have CP. Occupational therapists work closely with families in order to address their concerns and priorities for their child.[33] Family centered care is a paradigm that is often used with families with a child with CP. A review of how parents facilitate their child's participation found that parents typically "enable and support performance of meaningful activities" and "enable, change and use the environment", but that there is little written on parents' needs.[34]

CP commonly causes hemiplegia.[35] Those with hemiplegia have limited use of the limbs on one side of the body, and have normal use of the limbs on the other side.[35] People with hemiplegia often adapt by ignoring the limited limbs, and performing nearly all activities with the unaffected limbs, which can lead to increased problems with muscle tone, motor control and range of motion.[35] An emerging technique called constraint-induced movement therapy (CIMT) is designed to address this.[35] In CIMT, the unaffected limbs are constrained, forcing the individual to learn to use the affected limbs.[35] CIMT promotes increased motor function due to structural plasticity in the brain. [36] As of 2007 there was limited, preliminary evidence that CIMT is effective, but more study is needed before it can be recommended with confidence.[35] CIMT, modified CIMT, and forced use are three movement therapies that have been examined.[35] CIMT is defined as “restraint of the unaffected upper limb […], with more than three hours of therapy per day […] and is provided for at least two consecutive weeks”.[35] Children with hemiplegic cerebral palsy often have sensory impairments as well as motor deficits. CIMT has been shown to be an effective OT intervention to improve proprioception and sensory processing. [37] CIMT has also been found to improve postural symmetry during functional tasks in individuals with CP.[38]

Modified CIMT (mCIMT) is defined as “restraint of the unaffected upper limb and less than three hours per day of therapy provided to the affected limb”.[35] Forced use is when “restraint of the unaffected upper limb is applied but no additional treatment of the affected upper limb is provided”.[35] A review concluded that there is a positive trend favoring all three aforementioned therapies.[35]

A comparison of bimanual training (BIT) and CIMT found that there was no significant difference between the two in terms of effects. However, bimanual training may be more able to be integrated into a child's daily life, because the goals in bimanual training are more functional. CIMT has some advantages, such as therapists being able to solely focus on the affected arm, and the child having no choice but to use the affected arm in their activities of daily life as their unaffected arm is constrained. In bimanual training, the child may continue to use the unaffected arm to compensate if their therapist or parent does not remind them to use both hands.[39]

However, there is only some benefit from therapy. Treatment is usually symptomatic and focuses on helping the person to develop as many motor skills as possible or to learn how to compensate for the lack of them. Nonspeaking people with CP are often successful availing themselves of augmentative and alternative communication (AAC).[40]

Therapeutic tests for assessing balance do not appear to have good evidence for their reliability and responsiveness. The tests with the strongest evidence are the Trunk Control Measurement Scale and the Level of Sitting Scale (when measuring the ability to maintain balance), Timed Up and Go test (when measuring the ability to achieve balance), and the Segmental Assessment of Trunk Control (when restoring balance).[41]

Assistive technology

Assistive technology is commonly used to promote the independence of people with disabilities. Commonly used technologies for people with cerebral palsy can include patient lifts, electric wheelchairs, orthotics, seating systems, mealtime aids (such as large-handled cutlery and slip-resistant mats), mobility aids, standing frames, non-motorised wheelchairs, augmentative and alternative communication and speech-generating devices.[42] Scope has identified 3D printing as an area of promise in being able to print customised orthotics on-demand.[43]

Orthotic devices such as ankle-foot orthoses (AFOs) are often prescribed to achieve the following objectives: correct and/or prevent deformity, provide a base of support, facilitate training in skills, and improve the efficiency of gait.[44][45] The available evidence suggests that orthoses can have positive effects on all temporal and spatial parameters of gait, i.e. velocity, cadence, step length, stride length, single and double support.[46] AFOs have also been found to reduce energy expenditure.[47][48] Often children with CP require orthoses, such as casts and splints, to correct or prevent joint abnormalities, stabilize joints, prevent unwanted movement, allow desired movement, and prevent permanent muscle shortening.[49][50] Orthoses may also make it easier to dress or to maintain hygiene.[51] Lower limb splinting is specifically beneficial in providing a base of support and facilitating walking.[49] It is equally important that the child be able to carry out daily activities and prevent joint deformities.[49]

Children with CP have difficulties with mobility and posture. Occupational therapists often assess and prescribe seating equipment and wheelchairs. An appropriate wheelchair will stabilize the body so the child can use their arms for other activities. Wheelchairs therefore enhance independence.[52][53][51]

Accessible housing may assist some people with cerebral palsy, particularly wheelchair users.[54]

Assistive technologies used during sleep to position the body to prevent painful hip migration are called 'sleep positioning systems'. Studies on their effectiveness are of poor quality.[55]

Medication

Several kinds of medication have been used to treat the various kinds of cerebral palsy.[56] Adults with CP are more likely to use medication to manage pain than active pain management methods.

alt=Cartoon representation of Botulinum toxin. PDB entry 3BTA

Botulinum toxin injections are given into muscles that are spastic or sometimes dystonic, the aim being to reduce the muscle hypertonus that can be painful. A reduction in muscle tone can also facilitate bracing and the use of orthotics. Both lower extremity[57] and upper extremity[58] muscles are injected. Botulinum toxin is focal treatment, meaning that a limited number of muscles can be injected at the same time. The effect of the toxin is reversible and a reinjection may be needed every 4–6 months.[59] In children it decreases spasticity and improve range of motion and thus has become commonly used.[57][58][60] Botulin toxin has been used in CP treatment for around two decades and can be recommended for children above the age of two.[58][61] Two systematic reviews published in 2010 and 2020 found that there is high level evidence in the use of botulinum toxin as an add on therapy to occupational therapy among other physical therapies modalities in order to manage spasticity in the arms of children with cerebral palsy.[58][62] However, there is no strong research associated with the use of botulinum toxin in the management of spasticity in the legs or improving gait compared to casting.[63] More evidence related to the frequency and dosage of injections as it relates to long-term outcomes is needed in order to support or refute the use of botulinum toxin in the management of lower limb spasticity in children with cerebral palsy.[63]

Dosages of botulinum toxin have been based on expert opinion rather than evidence-based practices. The dosages recommended have recently been reduced to reduce severe side-effects including becoming sensitive to the botulin toxin and developing an allergic response. Higher risks have been noted with children who are at level IV and V on the GMFCS.[61] A review on the treatment of drooling in children with cerebral palsy found that it was not possible to tell whether interventions worked or were safe, including botulinum toxin A and benztropine and glycopyrrolate.[64]

Bisphosphonates are used to treat osteoporosis in adults. Osteoporosis is common in children with cerebral palsy, and non-oral bisphosphonates have been used to treat children with a very low bone mass density and a medical history of fragility fracture.[65]

A 2018 Cochrane review (one study met inclusion criteria) on the use of Trihexyphenidyl for dystonia found insufficient evidence of its effectiveness.[66]

Anticholinergics may be used to reduce drooling, but may contribute to constipation.[67]

Oral baclofen or diazepam is used to reduce spasticity which results in pain, muscle spasms or functional disability. Baclofen is used for a long-term effect and works at the spinal level. Diazepam is fast-acting.

Sometimes, medication used to manage physical aspects of CP can have effects on the person's mental health, or medications used to manage mental health can affect motor function.[68]

Orthopaedic surgery

Deformities in cerebral palsy children are inherently known for being Multiplane i.e. occurring in more than one plane such as transverse plane through which rotation occurs and sagittal plane through which flexion/extension of joint occurs. Furthermore, deformities in cerebral palsy children are characteristically multilevel i.e. occurring at simultaneously at more than one joint. This adds to the complexity of orthopedic management of cerebral palsy children. Thus, multilevel orthopedic surgery is the mainstay of orthopedic management. Multilevel orthopedic surgery may include soft tissue as tendon lengthening or transfer and/or bony surgery as corrective bone osteotomies. Multilevel orthopedic surgery is usually performed in one anesthetic sitting. This allows for the institution of one postoperative rehabilitation protocol and reduces hospital admission rates.[69][70] Orthopaedic surgery is widely used to correct fixed deformities and improve the functional capacity and gait pattern of children with CP. Dynamic deformities such as ankle equinus and hip adduction deformity leading to subluxation are usually managed conservatively with exercises; serial casting and botulinum toxin type A injections. This main goal of these conservative measures is to impede or prevent the happening of fixed or static joint deformities. Once joint contractures- fixed deformities - develop or joint subluxation or dislocation occurs, surgical treatment could become mandatory.[71][72][73] It is of paramount importance to delay the age at which orthopaedic surgical intervention becomes necessary as surgery early in life carries a greater risk of deformity recurrence especially in cases of ankle equines.[73][72] Additionally, unjustified lengthening of the tendon Achilles is fraught with risk of over lengthening and subsequent gait deterioration namely crouch gait.[73][72] In general, orthopaedic surgery for children with CP consists of tendon releases, lengthening, transposition and corrective osteotomies.[71][73][72] For example, fixed/static ankle equinus is usually managed by gastrocnemius-soleus aponeurotic lengthening or tendon Achilles lengthening.[72] Hip subluxation/dislocation is usually managed by adductor musculature release with or without a psoas tendon release together with femoral and pelvic osteotomies. This aims at hip joint containment and preservation.[71] In the event that hip joint dislocation becomes longstanding and painful in elder children or adolescence, hip salvage surgery may be an option to reduce pain help nursing and improve sitting balance. A variety of surgical procedures are included under hip salvage namely valgization osteotomy and femoral head resection. Total hip arthroplasty is recommended for those with a mature skeleton, who are also likely less severely impaired. Because CP is widely heterogeneous in its presentation, surgery should be considered on a case-by-case basis.[74]

Orthopaedic surgery usually involves one or a combination of:

  • Orthopaedic surgery as mentioned above involves releasing tight muscles and fixed joint contractures, and corrective osteotomies conducted basically to restore sagittal and rotational malalignment of bones. Orthopedic surgery is most often performed on the hips, knees, hamstrings, and ankles. For example, hip adductor release, musculotendinous lengthening for equinus gait, femoral derotataion osteotomy, and knee extension osteotomy are commonly practiced.[71][73][72] Less commonly, this surgery may be used for people with stiffness of their elbows, wrists, hands, and fingers.[75]

Other surgeries

  • The insertion of a baclofen pump usually during the stages while a person is a young adult. This is usually placed in the left abdomen. It is a pump that is connected to the spinal cord, whereby it releases doses of baclofen to alleviate continuous muscle flexion. Baclofen is a muscle relaxant and is often given by mouth to people to help counter the effects of spasticity, although this has the side effect of sedating the individual.[76] The pump can be adjusted if muscle tone is worse at certain times of the day or night. The baclofen pump is most appropriate for individuals with chronic, severe stiffness or uncontrolled muscle movement throughout the body.[77] There is a small amount of evidence that baclofen pumps are effective in the short term.[76]
  • Cutting nerves on the limbs most affected by movements and spasms. This procedure, called a rhizotomy ("rhizo" meaning root and "tomy" meaning "a cutting of" from the Greek suffix tomia), reduces spasms and allows more flexibility and control of the affected limbs and joints.[78][79]
  • Tracheotomy[80]
  • Dental surgery[80]
  • Diagnostic endoscopy[80]
  • Nissen fundoplication[80]

Other surgical procedures are available to try to help with other problems. Those who have serious difficulties with eating may undergo a procedure called a gastrostomy: a hole is cut through the belly skin and into the stomach to allow for a feeding tube.[81] There is no good evidence about the effectiveness or safety of gastrostomy.[81] Gastrostomies are associated with a lower life expectancy, this is probably due to underlying problems with swallowing rather than the procedure itself.[5]

Others

Whole-body vibration might improve speed, gross motor function and femur bone density in children with cerebral palsy.[82]

Aquatic therapy or hydrotherapy are commonly used therapies for children with CP, but evidence for their effectiveness is mixed.[83] Potential benefits of aquatic therapy is that children might find it more interesting than exercising on land, and they can try different kinds of movement such as jumping or skipping with less impact on their joints. While aquatic exercise is feasible and has low risk of adverse effects, the dose required to make a difference to gross motor skills is unclear.[84]

Hip surveillance is the term for monitoring a child with CP who is at risk of hip dislocation to try to prevent dislocation from happening.[85][71] The modern definition of cerebral palsy includes secondary skeletal effects on the child.[86] The Gross Motor Function Classification System is a good indicator of hip issues,[85][71] and more commonly occurs in children with spastic tetraplegia or spastic quadriplegia, but it is difficult to tell what type of CP a child has at the age where hip displacement might first become an issue (sometimes at 2 years old, but more commonly between 3 and 4 years old). Children are assessed for the risk of hip displacement using radiography.[71][87]

Music therapy has been used in CP to motivate or relax children, or used as auditory feedback. Playing percussion instruments has been used as part of groupwork in therapy. Piano lessons may be beneficial in CP rehabilitation, however more research is needed.[88]

While there is great interest in using video game rehabilitation with children with cerebral palsy, it is difficult to compare outcomes between studies, and therefore to reach evidence-based conclusions on its effectiveness.[89] Because video gaming is popular, it may help children's motivation to continue with the therapy.[90] There is moderate evidence for improvements with balance and motor skills in children and teens, but it is not recommended as an effective therapy.[22]

Service dogs may be used to assist people who have seizures as part of their CP.[1]

Yoga has been used by carers as part of the physical therapies for children to assist in developing basic motor skills.[91]

Alternative therapy

There has not been much research into the use of alternative medicine to treat cerebral palsy. Acupuncture has been used as a treatment for cerebral palsy since at least the 1980s, but as of 2009, there have been no Cochrane reviews of the effectiveness of acupuncture in the management of cerebral palsy.[92] In Traditional Chinese Medicine, cerebral palsy is often covered in the traditional diagnosis of "5 delayed syndrome".[93] Dolphin-assisted therapy, Adeli suits, and hyperbaric oxygen therapy have been criticised as being alternative medicine and contrary to the practice of evidence-based medicine.[94]

Hyperbaric oxygen therapy (HBOT), in which pressurised oxygen is inhaled inside a hyperbaric chamber, has been studied under the theory that improving oxygen availability to damaged brain cells can reactivate some of them to function normally. HBOT results in no significant difference from that of pressurised room air, however, and some children undergoing HBOT may experience adverse events such as seizures and the need for ear pressure equalisation tubes.[95]

Patterning is a controversial form of alternative therapy for people with CP. The method is promoted by The Institutes for the Achievement of Human Potential (IAHP), a Philadelphia nonprofit organisation, but has been criticised by the American Academy of Pediatrics.[96]

Conductive education (CE) was developed in Hungary from 1945 based on the work of András Pető. It is a unified system of rehabilitation for people with neurological disorders including cerebral palsy, Parkinson's disease and multiple sclerosis, amongst other conditions. It is theorised to improve mobility, self-esteem, stamina and independence as well as daily living skills and social skills. The conductor is the professional who delivers CE in partnership with parents and children. Skills learned during CE should be applied to everyday life and can help to develop age-appropriate cognitive, social and emotional skills. It is available at specialised centres.

Reviews disagree on the usefulness of therapy with horses – one found there was a positive effect on large scale motor function and another found that there was no evidence of improvements.[97][98]

Occupational therapists may use neuro-developmental techniques to promote normal movement and posture and to inhibit abnormal movement and posture.[51] Specific techniques include joint compression and stretching to provide sensory-motor input and to guide motor output.[51] Neurodevelopmental treatment, despite being commonly used as a therapy for children with CP, has not been found to have strong evidence for its use.[99] It has been suggested that rhythmic auditory stimulation may be more effective in improving gait than NDT techniques.[100]

Occupational therapy

Occupational Therapy (OT) enables individuals with cerebral palsy to participate in activities of daily living that are meaningful to them. A family-centred philosophy is used with children who have CP. Occupational therapists work closely with families in order to address their concerns and priorities for their child.[101] Occupational therapists may address issues relating to sensory, cognitive, or motor impairments resulting from CP that affect the child's participation in self-care, productivity, or leisure. Parent counselling is also an important aspect of occupational therapy treatment with regard to optimizing the parent's skills in caring for and playing with their child to support improvement of their child's abilities to do things.[53][102] The occupational therapist typically assesses the child to identify abilities and difficulties, and environmental conditions, such as physical and cultural influences, that affect participation in daily activities.[102] Occupational therapists may also recommend changes to the play space, changes to the structure of the room or building, and seating and positioning techniques to allow the child to play and learn effectively.[102][103]

Effect of sensory and perceptual impairments

Children with CP may experience decreased sensation or a limited understanding of how the brain interprets what it sees. Occupational therapists may plan and implement sensory-perceptual-motor (SPM) training for children with CP who have sensory impairments so that they learn to take in, understand, plan and produce organized behaviour.[104] The SPM training improves the daily, functional abilities of people with CP.[104] Occupational therapists may also use verbal instructions and supplementary visual input, such as visual cues, to help children with CP learn and carry out activities.

For children with CP with limited movement and sensation, the risk of pressure sores increases. Pressure sores often occur on bony parts of the body.[105] For example, pressure sores may occur when a child has limited feeling and movement of their lower body and uses a wheelchair; the tailbone bears weight when seated and can become vulnerable to pressure sores. The occupational therapist can educate the child, family, and caregivers about how to prevent pressure sores by monitoring the skin for areas of irritation, changing positions frequently, or using a tilt-in-space wheelchair.[105]

Effect of cognitive and perceptual impairments

OT can address cognitive and perceptual disabilities, especially of the visual-motor area.[53] For children with CP who have difficulty remembering the order and organization of self-care tasks in the morning, an occupational therapist can construct a morning routine schedule with reminders. An occupational therapist may analyze the steps involved in a task to break down an activity into simpler tasks. For example, dressing can be broken down into smaller, manageable steps. This can be done by having a caregiver lay out the clothing in order so the child knows what needs to be put on first.[51]

Effect of motor impairments

The effect of motor impairments is significant for children with CP because it affects the ability to walk, propel a wheelchair, maintain hygiene, access the community and interact with other people. Occupational therapists address motor impairments in a variety of ways and makes use of various techniques, depending on the child's needs and goals.[51] The occupational therapist may help the child with gross motor rehabilitation, or whole body and limb movements, through repetitive activities.[106][107] If the child has muscle weakness, progressive resistance exercises can improve muscular strength and endurance.[51] Fine motor rehabilitation, or small, specific movements, such as threading the eye of a needle, can be implemented to improve finger movement and control.[49]

For children with difficulties speaking, an occupational therapist may liaise with a speech therapist, carry out assessments, provide education and prescribe adaptive equipment. Adaptive equipment may include picture boards to help with communication and computers that respond to voice.[51]

Occupational therapists can help the child promote use of a neglected arm through techniques such as constraint-induced movement therapy (CIMT), which forces use of the unused arm by placing the other arm in a sling, cast or oversized mitt.[108]

Another OT technique that may be used is neuromuscular facilitation techniques, which involves physically moving and stretching the muscles to improve function so that the child can participate in activities.[102][103]

Spasticity is a common problem experienced by people with cerebral palsy. It can cause pain and loss of sleep, impair function in activities of daily living, and cause unnecessary complications. Spasticity is measured with the Ashworth scale. Occupational therapy targeting spasticity aims to lengthen the overactive muscles.[109] Some people with cerebral palsy use spasticity to compensate for muscle weakness, and so reducing spasticity can reduce function.[110]

OT role with factors influencing participation

Barriers to participation for children with CP include difficulty accessing the community. This includes difficulty accessing buildings and using transportation.[111][112] Occupational therapists may work with developers to ensure new homes are accessible to all people.[113][114] Also, occupational therapists often help people apply for government and non-profit funding to provide assistive devices, such as special computer programs or wheelchairs, to children with CP.[115] Availability of transportation services can be limited for children with CP because of many factors, such as difficulties fitting wheelchairs into vehicles and dependency on public transit schedules. Therefore, the occupational therapists may also be involved in education and referral regarding accessible vehicles and funding.[112][116]

Occupational therapists address the community and environmental factors that affect participation in leisure activities by educating children with CP, their families, and others on available options and adaptive ways to engage in leisure activities of interest.[114] Prejudice of others toward disability can also be a barrier to participation for children with CP with respect to leisure activities.[112] One way occupational therapists can address this barrier is to teach the child to educate others on CP – thus reducing stigma and enhancing participation.[115] Finally, occupational therapists take children's preferences into consideration in terms of cosmetic appearance when prescribing or fabricating adaptive equipment and splints. This is important as appearance may affect the child's compliance with assistive devices, as well as their self-confidence, which may impact participation. In addition to providing dedicated occupational therapy to such children, some non-profit organizations viz. Spastic Society of Gurgaon are providing comprehensive assistance which includes designing of child specific assisting devices to such children for making their lives more meaningful by enabling them to be self-reliant to the best possible extent.

Research

Most research into cerebral palsy covers children and adolescents.[100] Stem cell therapy,[117] and other cell-based therapies are being studied as a treatment.[4] A potential treatment for some forms of cerebral palsy may be deep brain stimulation.[118]As of 2016 it is thought that research in genetics and genomics, teratology, and developmental neuroscience is going to yield greater understanding of cerebral palsy.[119] Genetic testing may help find the etiology or comorbidities for types of cerebral palsy which could help in clarifying the classification systems for cerebral palsy.[4] In addition, experimenting with combinations of therapies may result in additional benefits.[4] A review which looked at research gaps in cerebral palsy identified neuroplasticity as an "underresearched opportunity for treating CP".[4]

Defining functional independence

Despite the transition in philosophy from treating individual body problems to treating the person with CP holistically, it has remained difficult to define what functional independence is. The Functional Independence Measure is sometimes used to describe people with CP.[120]

See also

References

  1. 1 2 3 4 5 6 Novak, Iona; Mcintyre, Sarah; Morgan, Catherine; Campbell, Lanie; Dark, Leigha; Morton, Natalie; Stumbles, Elise; Wilson, Salli-Ann; Goldsmith, Shona (October 2013). "A systematic review of interventions for children with cerebral palsy: state of the evidence". Developmental Medicine & Child Neurology. 55 (10): 885–910. doi:10.1111/dmcn.12246. PMID 23962350. S2CID 1658072.
  2. ↑ McGinley, Jennifer L.; Pogrebnoy, Dina; Morgan, Prue (2014). "Mobility in Ambulant Adults with Cerebral Palsy — Challenges for the Future". In Švraka, Emira (ed.). Cerebral Palsy - Challenges for the Future. doi:10.5772/58344. ISBN 978-953-51-1234-1. open access
  3. 1 2 Trabacca, Antonio; Vespino, Teresa; Di Liddo, Antonella; Russo, Luigi (September 2016). "Multidisciplinary rehabilitation for patients with cerebral palsy: improving long-term care". Journal of Multidisciplinary Healthcare. 9: 455–462. doi:10.2147/JMDH.S88782. PMC 5036581. PMID 27703369.
  4. 1 2 3 4 5 Lungu C, Hirtz D, Damiano D, Gross P, Mink JW (2016). "Report of a workshop on research gaps in the treatment of cerebral palsy". Neurology. 87 (12): 1293–8. doi:10.1212/WNL.0000000000003116. PMC 5035982. PMID 27558377.
  5. 1 2 National Guideline Alliance (UK) (January 2017). Cerebral Palsy in Under 25s: Assessment and Management (PDF). London: National Institute for Health and Care Excellence (UK). ISBN 978-1-4731-2272-7. Retrieved 5 February 2017. open access
  6. ↑ "Cerebral palsy - Treatment". www.nhs.uk. NHS Choices. 15 March 2017. Retrieved 6 February 2017.
  7. ↑ Pennington L, Goldbart J, Marshall J (2004). "Speech and language therapy to improve the communication skills of children with cerebral palsy". Cochrane Database Syst Rev (2): CD003466. doi:10.1002/14651858.CD003466.pub2. PMC 8407241. PMID 15106204.
  8. ↑ Verschuren, Olaf; Peterson, Mark D; Balemans, Astrid C J; Hurvitz, Edward A (August 2016). "Exercise and physical activity recommendations for people with cerebral palsy". Developmental Medicine & Child Neurology. 58 (8): 798–808. doi:10.1111/dmcn.13053. PMC 4942358. PMID 26853808.
  9. ↑ Zaffuto-Sforza, Celeste D. (February 2005). "Aging with cerebral palsy". Physical Medicine and Rehabilitation Clinics of North America. 16 (1): 235–249. doi:10.1016/j.pmr.2004.06.014. PMID 15561553.
  10. ↑ Heller, Tamar; Ying, Gui-shuang; Rimmer, James H.; Marks, Beth A. (May 2002). "Determinants of Exercise in Adults with Cerebral Palsy". Public Health Nursing. 19 (3): 223–231. doi:10.1046/j.0737-1209.2002.19311.x. PMID 11967109., as cited in Kent, Ruth M. (2012). "Cerebral palsy". In Barnes, Michael; Good, David (eds.). Neurological Rehabilitation Handbook of Clinical Neurology. Oxford: Elsevier Science. pp. 443–459. ISBN 9780444595843.
  11. ↑ Verschuren, Olaf; Smorenburg, Ana R.P.; Luiking, Yvette; Bell, Kristie; Barber, Lee; Peterson, Mark D. (2 February 2018). "Determinants of muscle preservation in individuals with cerebral palsy across the lifespan: a narrative review of the literature". Journal of Cachexia, Sarcopenia and Muscle. 9 (3): 453–464. doi:10.1002/jcsm.12287. PMC 5989853. PMID 29392922.
  12. ↑ Krops, L; Albada, T; Woude, L; Hijmans, J; Dekker, R (2017). "Anaerobic exercise testing in rehabilitation: A systematic review of available tests and protocols". Journal of Rehabilitation Medicine. 49 (4): 289–303. doi:10.2340/16501977-2213. PMID 28350415.
  13. ↑ Reedman, Sarah; Boyd, Roslyn N; Sakzewski, Leanne (March 2017). "The efficacy of interventions to increase physical activity participation of children with cerebral palsy: a systematic review and meta-analysis". Developmental Medicine & Child Neurology. 59 (10): 1011–1018. doi:10.1111/dmcn.13413. PMID 28318009. S2CID 11218539.
  14. ↑ Bloemen, Manon; Van Wely, Leontien; Mollema, Jurgen; Dallmeijer, Annet; de Groot, Janke (March 2017). "Evidence for increasing physical activity in children with physical disabilities: a systematic review". Developmental Medicine & Child Neurology. 59 (10): 1004–1010. doi:10.1111/dmcn.13422. PMID 28374442. open access
  15. ↑ Ryan, Jennifer M; Cassidy, Elizabeth E; Noorduyn, Stephen G; O'Connell, Neil E (11 June 2017). "Exercise interventions for cerebral palsy". The Cochrane Database of Systematic Reviews. 6: CD011660. doi:10.1002/14651858.CD011660.pub2. PMC 6481791. PMID 28602046.
  16. ↑ Burnfield, Judith M.; Cesar, Guilherme M.; Buster, Thad W.; Irons, Sonya L.; Pfeifer, Chase M. (October 2018). "Walking and Fitness Improvements in a Child With Diplegic Cerebral Palsy Following Motor-Assisted Elliptical Intervention". Pediatric Physical Therapy. 30 (4): E1–E7. doi:10.1097/PEP.0000000000000541. ISSN 1538-005X. PMID 30277973. S2CID 52908529.
  17. ↑ Booth, Adam T. C.; Buizer, Annemieke I.; Meyns, Pieter; Oude Lansink, Irene L. B.; Steenbrink, Frans; van der Krogt, Marjolein M. (September 2018). "The efficacy of functional gait training in children and young adults with cerebral palsy: a systematic review and meta-analysis". Developmental Medicine and Child Neurology. 60 (9): 866–883. doi:10.1111/dmcn.13708. ISSN 1469-8749. PMID 29512110.
  18. ↑ El-Shamy, Shamekh Mohamed (November 2017). "Effects of Antigravity Treadmill Training on Gait, Balance, and Fall Risk in Children With Diplegic Cerebral Palsy". American Journal of Physical Medicine & Rehabilitation. 96 (11): 809–815. doi:10.1097/PHM.0000000000000752. ISSN 1537-7385. PMID 28410250. S2CID 23585486.
  19. ↑ Stanton, Marion (2012). "Special Considerations". Understanding cerebral palsy : a guide for parents and professionals. London: Jessica Kingsley Publishers. p. 70. ISBN 9781849050609.
  20. 1 2 Sobralske, Mary C. (2013). "Common Physical or Sensory Disabilities". In Eddy, Linda L. (ed.). Caring for children with special healthcare needs and their families a handbook for healthcare professionals. Ames, Iowa: Wiley-Blackwell. p. 17. ISBN 9781118783290.
  21. ↑ Sewell, M. D.; Eastwood, D. M.; Wimalasundera, N. (25 September 2014). "Managing common symptoms of cerebral palsy in children". The BMJ. 349 (sep25 7): g5474. doi:10.1136/bmj.g5474. PMID 25255910. S2CID 45300547.
  22. 1 2 Ravi, D.K.; Kumar, N.; Singhi, P. (September 2016). "Effectiveness of virtual reality rehabilitation for children and adolescents with cerebral palsy: an updated evidence-based systematic review". Physiotherapy. 103 (3): 245–258. doi:10.1016/j.physio.2016.08.004. PMID 28109566.
  23. ↑ Patel, Dilip R.; Neelakantan, Mekala; Pandher, Karan; Merrick, Joav (2020). "Cerebral palsy in children: a clinical overview". Translational Pediatrics. 9 (Suppl 1): S125–S135. doi:10.21037/tp.2020.01.01. PMC 7082248. PMID 32206590.
  24. ↑ Pennington L, Goldbart J, Marshall J (2004). Pennington L (ed.). "Speech and language therapy to improve the communication skills of children with cerebral palsy". Cochrane Database of Systematic Reviews (2): CD003466. doi:10.1002/14651858.CD003466.pub2. PMC 8407241. PMID 15106204.
  25. ↑ Dursun, E; Dursun, N; Alican, D (21 January 2004). "Effects of biofeedback treatment on gait in children with cerebral palsy". Disability and Rehabilitation. 26 (2): 116–20. doi:10.1080/09638280310001629679. PMID 14668149. S2CID 12333696.
  26. ↑ Park, Eom-ji; Baek, Soon-hyung; Park, Soohee (2016). "Systematic review of the effects of mirror therapy in children with cerebral palsy". Journal of Physical Therapy Science. 28 (11): 3227–3231. doi:10.1589/jpts.28.3227. PMC 5140834. PMID 27942154.
  27. ↑ Darbois, Nelly; Guillaud, Albin; Pinsault, Nicolas (19 August 2018). "Do Robotics and Virtual Reality Add Real Progress to Mirror Therapy Rehabilitation? A Scoping Review". Rehabilitation Research and Practice. 2018: 6412318. doi:10.1155/2018/6412318. PMC 6120256. PMID 30210873.
  28. ↑ Macgregor R, Campbell R, Gladden MH, Tennant N, Young D (2007). "Effects of massage on the mechanical behaviour of muscles in adolescents with spastic diplegia: a pilot study". Developmental Medicine & Child Neurology. 49 (3): 187–191. doi:10.1111/j.1469-8749.2007.00187.x. PMID 17355474. S2CID 39591035.
  29. ↑ Zhou, Joanne; Butler, Erin E.; Rose, Jessica (17 March 2017). "Neurologic Correlates of Gait Abnormalities in Cerebral Palsy: Implications for Treatment". Frontiers in Human Neuroscience. 11: 103. doi:10.3389/fnhum.2017.00103. PMC 5355477. PMID 28367118.
  30. ↑ Booth, Adam T C; Buizer, Annemieke I; Meyns, Pieter; Oude Lansink, Irene L B; Steenbrink, Frans; van der Krogt, Marjolein M (7 March 2018). "The efficacy of functional gait training in children and young adults with cerebral palsy: a systematic review and meta-analysis". Developmental Medicine & Child Neurology. 60 (9): 866–883. doi:10.1111/dmcn.13708. PMID 29512110.
  31. ↑ Hansen, Ruth A.; Atchison, Ben (2000). Conditions in occupational therapy: effect on occupational performance. Hagerstown, MD: Lippincott Williams & Wilkins. ISBN 978-0-683-30417-6.
  32. ↑ Crepeau, Elizabeth Blesedell; Willard, Helen S.; Spackman, Clare S.; Neistadt, Maureen E. (1998). Willard and Spackman's occupational therapy. Philadelphia: Lippincott-Raven Publishers. ISBN 978-0-397-55192-7.
  33. ↑ Mulligan, Shelley (2003). Occupational therapy evaluation for children : a pocket guide. Philadelphia: Lippincott Williams & Wilkins. ISBN 9780781731638.
  34. ↑ Piškur, Barbara; Beurskens, Anna JHM; Jongmans, Marian J; Ketelaar, Marjolijn; Norton, Meghan; Frings, Christina A; Hemmingsson, Helena; Smeets, Rob JEM (8 November 2012). "Parents' actions, challenges, and needs while enabling participation of children with a physical disability: a scoping review". BMC Pediatrics. 12 (1): 177. doi:10.1186/1471-2431-12-177. PMC 3538071. PMID 23137074.
  35. 1 2 3 4 5 6 7 8 9 10 11 Hoare, Brian J.; Wallen, Margaret A.; Thorley, Megan N.; Jackman, Michelle L.; Carey, Leeanne M.; Imms, Christine (1 April 2019). "Constraint-induced movement therapy in children with unilateral cerebral palsy". The Cochrane Database of Systematic Reviews. 4: CD004149. doi:10.1002/14651858.CD004149.pub3. ISSN 1469-493X. PMC 6442500. PMID 30932166.
  36. ↑ Hu, Jian; Liu, Pei-Le; Hua, Yan; Gao, Bei-Yao; Wang, Yu-Yuan; Bai, Yu-Long; Chen, Chan (2021-02-01). "Constraint-induced movement therapy enhances AMPA receptor-dependent synaptic plasticity in the ipsilateral hemisphere following ischemic stroke". Neural Regeneration Research. 16 (2): 319–319.
  37. ↑ D'Souza, S; Master, S; Jobst, C; Switzer, L; Cheyne, D; Fehlings, D (2015-06-01). "27: Exploring Sensorimotor Plasticity in Hemiplegic Cerebral Palsy Following Constraint-Induced Movement Therapy". Paediatrics & Child Health. 20 (5): e43–e43. doi:10.1093/pch/20.5.e43. ISSN 1205-7088.
  38. ↑ Dallman, Aaron; Holland, Holly; Haynes, Margo; Blazek, Kerry (2019-08-01). "Tracking Changes in Postural Symmetry Using Pressure Mapping Systems in Children With Cerebral Palsy Receiving Constraint-Induced Movement Therapy (CIMT)". American Journal of Occupational Therapy. 73 (4_Supplement_1): 7311515382p1–7311515382p1. doi:10.5014/ajot.2019.73S1-PO8048. ISSN 0272-9490.
  39. ↑ Dong, Vicky An-Qin; Tung, Ivy Hsi-Hsuan; Siu, Hester Wai-Yi; Fong, Kenneth Nai-Kuen (4 September 2012). "Studies comparing the efficacy of constraint-induced movement therapy and bimanual training in children with unilateral cerebral palsy: A systematic review". Developmental Neurorehabilitation. 16 (2): 133–143. doi:10.3109/17518423.2012.702136. hdl:10397/20811. PMID 22946588. S2CID 207647976.
  40. ↑ Clarke, Michael; Price, Katie (2012). "Augmentative and alternative communication for children with cerebral palsy" (PDF). Paediatrics and Child Health. 22 (9): 367–71. doi:10.1016/j.paed.2012.03.002.
  41. ↑ Saether, Rannei; Helbostad, Jorunn L; Riphagen, Ingrid I; Vik, Torstein (November 2013). "Clinical tools to assess balance in children and adults with cerebral palsy: a systematic review". Developmental Medicine & Child Neurology. 55 (11): 988–999. doi:10.1111/dmcn.12162. PMID 23679987. S2CID 205066936.
  42. ↑ "Assistive Technology, Mobility and Customised Seating | Cerebral Palsy Alliance". www.cerebralpalsy.org.au. Cerebral Palsy Alliance. Archived from the original on 5 February 2017. Retrieved 5 February 2017.
  43. ↑ "Disability Innovations: How 3D printing will make orthotics smarter, faster and cheaper". Scope's Blog. Scope. 3 March 2015. Retrieved 5 February 2017.
  44. ↑ Condie DN, Meadows CB. Conclusions and recommendations. In: Condie DN, Meadows CB, eds. Report of a Consensus Conference on the Lower Limb Orthotic Management of Cerebral Palsy. Copenhagen: International Society of Prosthetics & Orthotics; 1995:15-19
  45. ↑ Eddison, Nicola; Chockalingam, Nachiappan (April 2013). "The effect of tuning ankle foot orthoses–footwear combination on the gait parameters of children with cerebral palsy". Prosthetics & Orthotics International. 37 (2): 95–107. doi:10.1177/0309364612450706.
  46. ↑ Ross, K; Bowers, R (2009). "A review of the effectiveness of lower limb orthoses used in cerebral palsy". Recent developments in healthcare for cerebral palsy : implications and opportunities for orthotics : report of an ISPO conference held at Wolfson College, Oxford, 8-11 September 2008. Copenhagen: International Society for Prosthetics and Orthotics (ISPO). pp. 235–297. ISBN 978-87-89809-28-1.
  47. ↑ Balaban B, Yasar E, Dal U, Yazicioglu K, Mohur H, Kalyon TA (2007). "The effect of hinged ankle-foot orthosis on gait and energy expenditure in spastic hemiplegic cerebral palsy". Disability and Rehabilitation. 29 (2): 139–144. doi:10.1080/17483100600876740. PMID 17373095. S2CID 42121751.
  48. ↑ Eddison, N.; Healy, A.; Needham, R.; Chockalingam, N. (June 2020). "The effect of tuning ankle foot orthoses-footwear combinations on gait kinematics of children with cerebral palsy: A case series". The Foot. 43: 101660. doi:10.1016/j.foot.2019.101660.
  49. 1 2 3 4 Autti-Rämö I, Suoranta J, Anttila H, Malmivaara A, Mäkelä M (2006). "Effectiveness of upper and lower limb casting and orthoses in children with cerebral palsy: an overview of review articles". American Journal of Physical Medicine & Rehabilitation. 85 (1): 89–103. doi:10.1097/01.phm.0000179442.59847.27. PMID 16357554. S2CID 33892864.
  50. ↑ Boyd RN, Morris ME, Graham HK (2001). "Management of upper limb dysfunction in children with cerebral palsy: a systematic review". European Journal of Neurology. 8 (Suppl 5): 150–66. doi:10.1046/j.1468-1331.2001.00048.x. PMID 11851744. S2CID 23824032.
  51. 1 2 3 4 5 6 7 8 Gormley, Mark E. (2001). "Treatment of neuromuscular and musculoskeletal problems in cerebral palsy". Pediatric Rehabilitation. 4 (1): 5–16. doi:10.1080/13638490151068393. PMID 11330850.
  52. ↑ Miller F, Bachrach SJ, Bachrach SJ. Cerebral palsy: A complete guide for caregiving. : Johns Hopkins University Press; 1995.
  53. 1 2 3 Steultjens, Esther MJ; Dekker, Joost; Bouter, Lex M; van de Nes, Jos CM; Lambregts, Brigitte LM; van den Ende, Cornelia HM (February 2004). "Occupational therapy for children with cerebral palsy: a systematic review" (PDF). Clinical Rehabilitation. 18 (1): 1–14. doi:10.1191/0269215504cr697oa. hdl:1871/22273. PMID 14763715. S2CID 10245939.
  54. ↑ Švraka, Emira (2014). "Cerebral Palsy and Accessible Housing". In Švraka, Emira (ed.). Cerebral Palsy - Challenges for the Future. doi:10.5772/56983. ISBN 978-953-51-1234-1. open access
  55. ↑ Blake, Sharon F; Logan, Stuart; Humphreys, Ginny; Matthews, Justin; Rogers, Morwenna; Thompson-Coon, Joanna; Wyatt, Katrina; Morris, Christopher (2 November 2015). "Sleep positioning systems for children with cerebral palsy". Cochrane Database of Systematic Reviews (11): CD009257. doi:10.1002/14651858.cd009257.pub2. hdl:10871/18583. PMID 26524348.
  56. ↑ Norton, Neil S. (2007). "Cerebral Palsy". XPharm: The Comprehensive Pharmacology Reference. New York: Elsevier. pp. 1–5. doi:10.1016/B978-008055232-3.60641-5. ISBN 978-0-08-055232-3.
  57. 1 2 Blumetti, Francesco C; Belloti, João Carlos; Tamaoki, Marcel JS; Pinto, José A (8 October 2019). "Botulinum toxin type A in the treatment of lower limb spasticity in children with cerebral palsy". Cochrane Database of Systematic Reviews. 10: CD001408. doi:10.1002/14651858.CD001408.pub2. PMC 6779591. PMID 31591703.
  58. 1 2 3 4 Farag, Sara M.; Mohammed, Manal O.; EL-Sobky, Tamer A.; ElKadery, Nadia A.; ElZohiery, Abeer K. (March 2020). "Botulinum Toxin A Injection in Treatment of Upper Limb Spasticity in Children with Cerebral Palsy: A Systematic Review of Randomized Controlled Trials". JBJS Reviews. 8 (3): e0119. doi:10.2106/JBJS.RVW.19.00119. PMC 7161716. PMID 32224633.
  59. ↑ Heinen F, Desloovere K, Schroeder AS, et al. (January 2010). "The updated European Consensus 2009 on the use of Botulinum toxin for children with cerebral palsy". Eur. J. Paediatr. Neurol. 14 (1): 45–66. doi:10.1016/j.ejpn.2009.09.005. PMID 19914110.
  60. ↑ Apkon SD, Cassidy D (2010). "Safety considerations in the use of botulinum toxins in children with cerebral palsy". PM&R. 2 (4): 282–4. doi:10.1016/j.pmrj.2010.02.006. PMID 20430330. S2CID 207402134.
  61. 1 2 Strobl, Walter; Theologis, Tim; Brunner, Reinald; Kocer, Serdar; Viehweger, Elke; Pascual-Pascual, Ignacio; Placzek, Richard (11 May 2015). "Best Clinical Practice in Botulinum Toxin Treatment for Children with Cerebral Palsy". Toxins. 7 (5): 1629–1648. doi:10.3390/toxins7051629. PMC 4448165. PMID 25969944.
  62. ↑ Hoare, Brian J.; Wallen, Margaret A.; Imms, Christine; Villanueva, Elmer; Rawicki, Hyam Barry; Carey, Leeanne (20 January 2010). "Botulinum toxin A as an adjunct to treatment in the management of the upper limb in children with spastic cerebral palsy (UPDATE)". The Cochrane Database of Systematic Reviews (1): CD003469. doi:10.1002/14651858.CD003469.pub4. ISSN 1469-493X. PMC 7154577. PMID 20091546.
  63. 1 2 Ade-Hall, R. A.; Moore, A. P. (2000). "Botulinum toxin type A in the treatment of lower limb spasticity in cerebral palsy". The Cochrane Database of Systematic Reviews (2): CD001408. doi:10.1002/14651858.CD001408. ISSN 1469-493X. PMID 10796784.
  64. ↑ Walshe, M; Smith, M; Pennington, L (14 November 2012). Walshe, Margaret (ed.). "Interventions for drooling in children with cerebral palsy". The Cochrane Database of Systematic Reviews. 11: CD008624. doi:10.1002/14651858.CD008624.pub3. PMID 23152263.
  65. ↑ Boyce, Alison M.; Tosi, Laura L.; Paul, Scott M. (May 2014). "Bisphosphonate Treatment for Children With Disabling Conditions". PM&R. 6 (5): 427–436. doi:10.1016/j.pmrj.2013.10.009. PMC 4037384. PMID 24368091.
  66. ↑ Harvey, Adrienne R.; Baker, Louise B.; Reddihough, Dinah Susan; Scheinberg, Adam; Williams, Katrina (2018-05-15). "Trihexyphenidyl for dystonia in cerebral palsy". The Cochrane Database of Systematic Reviews. 5: CD012430. doi:10.1002/14651858.CD012430.pub2. ISSN 1469-493X. PMC 6494536. PMID 29763510.
  67. ↑ Robin C. Meyers; Steven J. Bachrach; Virginia A. Stallings (2017). "Cerebral Palsy". In Shirley W. Ekvall; Valli K. Ekvall (eds.). Pediatric and Adult Nutrition in Chronic Diseases, Developmental Disabilities, and Hereditary Metabolic Disorders: Prevention, Assessment, and Treatment. Oxford Scholarship Online. doi:10.1093/acprof:oso/9780199398911.003.0009. ISBN 9780199398911.
  68. ↑ Assessing and monitoring complications and comorbidities associated with cerebral palsy in adults aged 25 and over. National Institute for Health and Care Excellence (UK).
  69. ↑ Galey, SA; Lerner, ZF; Bulea, TC; Zimbler, S; Damiano, DL (May 2017). "Effectiveness of surgical and non-surgical management of crouch gait in cerebral palsy: A systematic review". Gait & Posture. 54: 93–105. doi:10.1016/j.gaitpost.2017.02.024. PMID 28279852.
  70. ↑ Dreher, T; Thomason, P; Švehlík, M; Döderlein, L; Wolf, SI; Putz, C; Uehlein, O; Chia, K; Steinwender, G; Sangeux, M; Graham, HK (January 2018). "Long-term development of gait after multilevel surgery in children with cerebral palsy: a multicentre cohort study". Developmental Medicine and Child Neurology. 60 (1): 88–93. doi:10.1111/dmcn.13618. PMID 29171016.
  71. 1 2 3 4 5 6 7 El-Sobky, TA; Fayyad, TA; Kotb, AM; Kaldas, B (25 September 2017). "Bony reconstruction of hip in cerebral palsy children Gross Motor Function Classification System levels III to V: a systematic review". Journal of Pediatric Orthopedics. Part B. 27 (3): 221–230. doi:10.1097/BPB.0000000000000503. PMID 28953164. S2CID 4204446.
  72. 1 2 3 4 5 6 Shore, Benjamin J.; White, Nathan; Kerr Graham, H. (August 2010). "Surgical correction of equinus deformity in children with cerebral palsy: a systematic review". Journal of Children's Orthopaedics. 4 (4): 277–290. doi:10.1007/s11832-010-0268-4. PMC 2908346. PMID 21804889.
  73. 1 2 3 4 5 Gendy, S; ElGebeily, M; El-Sobky, TA; Khoshhal, KI; Jawadi, AH (2019). "Current practice and preferences to management of equinus in children with ambulatory cerebral palsy: A survey of orthopedic surgeons". SICOT-J. 5: 3. doi:10.1051/sicotj/2019003. PMC 6394235. PMID 30816087.
  74. ↑ de Souza, Rafael Carboni; Mansano, Marcelo Valentim; Bovo, Miguel; Yamada, Helder Henzo; Rancan, Daniela Regina; Fucs, Patricia Maria de Moraes Barros; Svartman, Celso; de Assumpção, Rodrigo Montezuma César (May 2015). "Hip salvage surgery in cerebral palsy cases: a systematic review". Revista Brasileira de Ortopedia (English Edition). 50 (3): 254–259. doi:10.1016/j.rboe.2015.06.003. PMC 4519665. PMID 26229926.
  75. ↑ Cristella, G; Filippi, MC; Mori, M; Alboresi, S; Ferrari, A (February 2019). "Evaluation of hand function in patients with unilateral cerebral palsy who underwent multilevel functional surgery: a retrospective observational study". European Journal of Physical and Rehabilitation Medicine. 55 (1): 123–130. doi:10.23736/S1973-9087.18.04904-3. hdl:11380/1169105. PMID 30156083.
  76. 1 2 Hasnat, Monika J; Rice, James E (13 November 2015). "Intrathecal baclofen for treating spasticity in children with cerebral palsy". The Cochrane Database of Systematic Reviews (11): CD004552. doi:10.1002/14651858.CD004552.pub2. PMID 26563961.
  77. ↑ "Cerebral Palsy: Hope Through Research". National Institute of Neurological Disorders and Stroke (U.S.). NIH Publication No. 13-159. August 2013. Retrieved 2014-01-23.
  78. ↑ Farmer JP, Sabbagh AJ (2007). "Selective dorsal rhizotomies in the treatment of spasticity related to cerebral palsy". Child's Nervous System. 23 (9): 991–1002. doi:10.1007/s00381-007-0398-2. PMID 17643249. S2CID 20969076.
  79. ↑ Carraro, Elena; Zeme, Sergio; Ticcinelli, Valentina; Massaroni, Carlo; Santin, Michela; Peretta, Paola; Martinuzzi, Andrea; Trevisi, Enrico (November 2014). "Multidimensional outcome measure of selective dorsal rhizotomy in spastic cerebral palsy". European Journal of Paediatric Neurology. 18 (6): 704–713. doi:10.1016/j.ejpn.2014.06.003. PMID 24954890.
  80. 1 2 3 4 Shaikh, SafiyaImtiaz; Hegade, Ganapati (2017). "Role of anesthesiologist in the management of a child with cerebral palsy". Anesthesia: Essays and Researches. 11 (3): 544–549. doi:10.4103/0259-1162.194569. PMC 5594763. PMID 28928544.
  81. 1 2 Gantasala, S.; Sullivan, PB.; Thomas, AG. (2013). "Gastrostomy feeding versus oral feeding alone for children with cerebral palsy". Cochrane Database Syst Rev. 7 (7): CD003943. doi:10.1002/14651858.CD003943.pub3. PMC 7154382. PMID 23900969.
  82. ↑ Saquetto, M; Carvalho, V; Silva, C; Conceição, C; Gomes-Neto, M (June 2015). "The effects of whole body vibration on mobility and balance in children with cerebral palsy: a systematic review with meta-analysis". Journal of Musculoskeletal & Neuronal Interactions. 15 (2): 137–144. PMC 5133716. PMID 26032205.
  83. ↑ Franki, I; Desloovere, K; Cat, J; Feys, H; Molenaers, G; Calders, P; Vanderstraeten, G; Himpens, E; Broeck, C (2012). "The evidence-base for conceptual approaches and additional therapies targeting lower limb function in children with cerebral palsy: A systematic review using the ICF as a framework". Journal of Rehabilitation Medicine. 44 (5): 396–405. doi:10.2340/16501977-0984. PMID 22549647.
  84. ↑ Roostaei, Meysam; Baharlouei, Hamzeh; Azadi, Hamidreza; Fragala-Pinkham, Maria A. (14 December 2016). "Effects of Aquatic Intervention on Gross Motor Skills in Children with Cerebral Palsy: A Systematic Review". Physical & Occupational Therapy in Pediatrics. 37 (5): 496–515. doi:10.1080/01942638.2016.1247938. PMID 27967298. S2CID 36672683.
  85. 1 2 Wynter, Meredith; Gibson, Noula; Willoughby, Kate L; Love, Sarah; Kentish, Megan; Thomason, Pam; Graham, H Kerr (September 2015). "Australian hip surveillance guidelines for children with cerebral palsy: 5-year review". Developmental Medicine & Child Neurology. 57 (9): 808–820. doi:10.1111/dmcn.12754. PMID 25846730. S2CID 9923510.
  86. ↑ Johari, Ratna; Maheshwari, Shalin; Thomason, Pam; Khot, Abhay (23 January 2016). "Musculoskeletal Evaluation of Children with Cerebral Palsy". The Indian Journal of Pediatrics. 83 (11): 1280–1288. doi:10.1007/s12098-015-1999-5. PMID 26801500. S2CID 4960784.
  87. ↑ Robb, J. E.; Hägglund, G. (18 August 2013). "Hip surveillance and management of the displaced hip in cerebral palsy". Journal of Children's Orthopaedics. 7 (5): 407–413. doi:10.1007/s11832-013-0515-6. PMC 3838516. PMID 24432103.
  88. ↑ Alves-Pinto, Ana; Turova, Varvara; Blumenstein, Tobias; Lampe, Renée (2016). "The Case for Musical Instrument Training in Cerebral Palsy for Neurorehabilitation". Neural Plasticity. 2016: 1072301. doi:10.1155/2016/1072301. PMC 5102741. PMID 27867664.
  89. ↑ Bonnechère, B.; Jansen, B.; Omelina, L.; Degelaen, M.; Wermenbol, V.; Rooze, M.; Van Sint Jan, S. (August 2014). "Can serious games be incorporated with conventional treatment of children with cerebral palsy? A review". Research in Developmental Disabilities. 35 (8): 1899–1913. doi:10.1016/j.ridd.2014.04.016. PMID 24794289.
  90. ↑ Gunel, Mintaze Kerem; Kara, Ozgun Kaya; Ozal, Cemil; Turker, Duygu (2014). "Virtual Reality in Rehabilitation of Children with Cerebral Palsy". In Švraka, Emira (ed.). Cerebral Palsy - Challenges for the Future. doi:10.5772/57486. ISBN 978-953-51-1234-1. open access
  91. ↑ Sumar, Sonia (1998). Yoga for the Special Child: a therapeutic Approach for Infants and Children with Down Syndrome, Cerebral Palsy, Learning Disabilities. New York: Special Yoga Publications. ISBN 9780615491257.
  92. ↑ OPPENHEIM, WILLIAM L (October 2009). "Complementary and alternative methods in cerebral palsy". Developmental Medicine & Child Neurology. 51: 122–129. doi:10.1111/j.1469-8749.2009.03424.x. PMID 19740219. S2CID 23728329.
  93. ↑ Wong, Virginia; Wen-xiong, Chen (2006). "Is Acupuncture Useful for Cerebral Palsy? What Evidence Do We Have?". In Fong, Helen D. (ed.). Trends in Cerebral Palsy Research. New York: Nova Science Publishers. pp. 139–165. ISBN 9781594544484.
  94. ↑ Weisleder, Pedro (January 2010). "Unethical Prescriptions: Alternative Therapies for Children With Cerebral Palsy". Clinical Pediatrics. 49 (1): 7–11. doi:10.1177/0009922809340438. PMID 19628756. S2CID 19719686.
  95. ↑ McDonagh MS, Morgan D, Carson S, Russman BS (2007). "Systematic review of hyperbaric oxygen therapy for cerebral palsy: the state of the evidence". Dev Med Child Neurol. 49 (12): 942–947. doi:10.1111/j.1469-8749.2007.00942.x. PMID 18039243. S2CID 41133212.
  96. ↑ American Academy of Pediatrics. Committee on Children with Disabilities (1999). "The treatment of neurologically impaired children using patterning". Pediatrics. 104 (5): 1149–1151. doi:10.1542/peds.104.5.1149. PMID 10545565.
  97. ↑ Whalen, Cara N.; Case-Smith, Jane (29 November 2011). "Therapeutic Effects of Horseback Riding Therapy on Gross Motor Function in Children with Cerebral Palsy: A Systematic Review". Physical & Occupational Therapy in Pediatrics. 32 (3): 229–242. doi:10.3109/01942638.2011.619251. PMID 22122355. S2CID 8608723.
  98. ↑ Tseng, Sung-Hui; Chen, Hung-Chou; Tam, Ka-Wai (26 May 2012). "Systematic review and meta-analysis of the effect of equine assisted activities and therapies on gross motor outcome in children with cerebral palsy". Disability and Rehabilitation. 35 (2): 89–99. doi:10.3109/09638288.2012.687033. PMID 22630812. S2CID 1611996.
  99. ↑ Sakzewski, L.; Ziviani, J.; Boyd, R. N. (23 December 2013). "Efficacy of Upper Limb Therapies for Unilateral Cerebral Palsy: A Meta-analysis". Pediatrics. 133 (1): e175–e204. doi:10.1542/peds.2013-0675. PMID 24366991.
  100. 1 2 Lawrence, Hillary; Hills, Sara; Kline, Nicole; Weems, Kyra; Doty, Antonette (November 2016). "Effectiveness of Exercise on Functional Mobility in Adults with Cerebral Palsy: A Systematic Review". Physiotherapy Canada. 68 (4): 398–407. doi:10.3138/ptc.2015-38LHC. PMC 5125497. PMID 27904240.
  101. ↑ Mulligan S, Neistadt ME. Occupational therapy evaluation for children: a pocket guide. : Lippincott Williams & Wilkins; 2003.
  102. 1 2 3 4 Neistadt ME. Occupational therapy evaluation for adults: a pocket guide. : Lippincott Williams & Wilkins; 2000.
  103. 1 2 Guidetti, Susanne; Söderback, Ingrid (March 2001). "Description of self-care training in occupational therapy: case studies of five Kenyan children with cerebral palsy". Occupational Therapy International. 8 (1): 34–48. doi:10.1002/oti.130. PMID 11823869.
  104. 1 2 Kayihan, Gonca Bumin, Hulya (7 July 2009). "Effectiveness of two different sensory-integration programmes for children with spastic diplegic cerebral palsy". Disability and Rehabilitation. 23 (9): 394–399. doi:10.1080/09638280010008843. PMID 11394590. S2CID 22042703.
  105. 1 2 Chin, Terence Y.P.; Duncan, Josie A.; Johnstone, Bruce R.; Kerr Graham, H. (November 2005). "Management of the upper limb in cerebral palsy". Journal of Pediatric Orthopaedics B. 14 (6): 389–404. doi:10.1097/01202412-200511000-00001. PMID 16200013.
  106. ↑ Anttila H, Suoranta J, Malmivaara A, Mäkelä M, Autti-Rämö I (2008). "Effectiveness of physiotherapy and conductive education interventions in children with cerebral palsy: a focused review". American Journal of Physical Medicine & Rehabilitation. 87 (6): 478–501. doi:10.1097/PHM.0b013e318174ebed. PMID 18496250. S2CID 22572689.
  107. ↑ Morris, Christopher (December 2002). "Orthotic Management of Children with Cerebral Palsy". Journal of Prosthetics and Orthotics. 14 (4): 150–158. doi:10.1097/00008526-200212000-00005. S2CID 72337608.
  108. ↑ Canadian Association of Occupational Therapists Position Statement (June 2003). "Universal design and occupational therapy". Canadian Journal of Occupational Therapy. 70 (3): 187–90. PMID 12846113. {{cite journal}}: |author1= has generic name (help)
  109. ↑ Shamsoddini A, Amirsalari S, Hollisaz MT, Rahimnia A, Khatibi-Aghda A (2014). "Management of spasticity in children with cerebral palsy". Iranian Journal of Pediatrics. 24 (4): 345–51. PMC 4339555. PMID 25755853.
  110. ↑ Smith, Martin; Kurian, Manju A. (September 2016). "The medical management of cerebral palsy" (PDF). Paediatrics and Child Health. 26 (9): 378–382. doi:10.1016/j.paed.2016.04.013.
  111. ↑ Imms, Christine (7 July 2009). "Children with cerebral palsy participate: A review of the literature". Disability and Rehabilitation. 30 (24): 1867–1884. doi:10.1080/09638280701673542. PMID 19037780. S2CID 20859782.
  112. 1 2 3 Specht, J.; King, G.; Brown, E.; Foris, C. (1 July 2002). "The Importance of Leisure in the Lives of Persons With Congenital Physical Disabilities". American Journal of Occupational Therapy. 56 (4): 436–445. doi:10.5014/ajot.56.4.436. PMID 12125833.
  113. ↑ Ringaert, L. (2002). "Universal design and occupational therapy". Occupational Therapy Now. 4: 28–30.
  114. 1 2 Wittman, Peggy Prince; Velde, Beth P. (3 August 2009). "Occupational Therapy in the Community: What, Why, and How". Occupational Therapy in Health Care. 13 (3–4): 1–5. doi:10.1080/J003v13n03_01. PMID 23944256. S2CID 5532770.
  115. 1 2 Bruce MA, Borg B. Psychosocial frames of reference: core for occupation-based practice. : Slack Incorporated; 2002.
  116. ↑ Norton K. Transportation Options for People with Disabilities. 2002-2010; Available at: "Archived copy". Archived from the original on July 6, 2011. Retrieved 2010-05-18.{{cite web}}: CS1 maint: archived copy as title (link). Accessed April 12, 2010.
  117. ↑ Bennet, L; Tan, S; Van den Heuij, L; Derrick, M; Groenendaal, F; van Bel, F; Juul, S; Back, SA; Northington, F; Robertson, NJ; Mallard, C; Gunn, AJ (May 2012). "Cell therapy for neonatal hypoxia-ischemia and cerebral palsy". Annals of Neurology. 71 (5): 589–600. doi:10.1002/ana.22670. PMID 22522476. S2CID 23640108.
  118. ↑ Koy, A; Hellmich, M; Pauls, KAM; Marks, W; Lin, J-P; Fricke, O; Timmermann, L (May 2013). "Effects of deep brain stimulation in dyskinetic cerebral palsy: A meta-analysis". Movement Disorders. 28 (5): 647–654. doi:10.1002/mds.25339. PMID 23408442. S2CID 21333749.
  119. ↑ Nelson KB, Blair E (2015). "Prenatal Factors in Singletons with Cerebral Palsy Born at or near Term". The New England Journal of Medicine. 373 (10): 946–53. doi:10.1056/NEJMra1505261. PMID 26332549.
  120. ↑ Posłuszny, Adam; Myśliwiec, Andrzej; Saulicz, Edward; Doroniewicz, Iwona; Linek, Paweł; Wolny, Tomasz (4 March 2016). "Current understanding of the factors influencing the functional independence of people with cerebral palsy: a review of the literature". International Journal of Developmental Disabilities. 63 (2): 77–90. doi:10.1080/20473869.2016.1145396. S2CID 147588114.

Further reading

  • Dodd, Karen J.; Imms, Christine; Taylor, Nicholas F., eds. (2010). Physiotherapy and occupational therapy for people with cerebral palsy: a problem-based approach to assessment and management. London: Mac Keith Press. ISBN 978-1-908316-11-0.
The offline app allows you to download all of Wikipedia's medical articles in an app to access them when you have no Internet.
Wikipedia's health care articles can be viewed offline with the Medical Wikipedia app.
This article is issued from Offline. The text is licensed under Creative Commons - Attribution - Sharealike. Additional terms may apply for the media files.