Clown-care reduces pain in children with cerebral palsy undergoing recurrent botulinum toxin injections- A quasi-randomized controlled crossover study

Ben‐Pazi, Hilla; Cohen, Avraham; Kroyzer, Naama; Lotem-Ophir, Renana; Shvili, Yaakov; Winter, Gidon; Deutsch, Lisa; Pollak, Yehuda

doi:10.1371/journal.pone.0175028

Cited by 38 publications

(37 citation statements)

References 37 publications

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“…Quality assessment of level I to level III studies found ( n =number of studies): strong ( n =2), moderate ( n =12), and weak ( n =8) quality. Adequate conduct and report of appropriate statistical evaluation including power evaluations was described in nine studies . Suitable methods for controlling confounding variables and limiting potential biases were not reported in any studies.…”

Section: Resultsmentioning

confidence: 99%

“…Management of procedural pain was evaluated for ( n =number of studies): intramuscular BoNT‐A injections ( n =5), acupuncture ( n =1), and venepuncture ( n =1) …”

Section: Resultsmentioning

confidence: 99%

“…Pain during BoNT‐A injections was managed with: inhaled nitrous oxide with topical anaesthetic cream ( n =2); ketamine with midazolam ( n =2); and clown‐care therapy ( n =1) . Observational studies reported mixed evidence for the efficacy of inhaled nitrous oxide with topical anaesthetic cream.…”

Section: Resultsmentioning

confidence: 99%

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Management of pain in children and adolescents with cerebral palsy: a systematic review

Ostojic

Paget

Morrow

2018

Develop Med Child Neuro

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ABBREVIATIONS BoNT-A Intramuscular botulinum toxin-A VAS Visual analogue scale ITB Intrathecal baclofen AIM To determine the efficacy of interventions for the management of pain in children and adolescents with cerebral palsy (CP). METHOD Electronic databases were searched from the earliest date possible to April 2018 using a mixture of subject headings and free text. Inclusion criteria comprised of studies with (1) diagnosis of CP, (2) under the age of 18 years, (3) intervention for the management of pain, (4) outcome measure of pain, and (5) studies published in English-language peerreviewed journals. RESULTS Fifty-seven studies met the eligibility criteria. Pain related to (n=number of studies): hypertonia (n=17), spastic hip disease (n=13), procedures for the management of CP (n=7), postoperative (n=18), and other (n=2). Most of the studies were of level III to level V evidence.

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Section: Resultsmentioning

confidence: 99%

“…Management of procedural pain was evaluated for ( n =number of studies): intramuscular BoNT‐A injections ( n =5), acupuncture ( n =1), and venepuncture ( n =1) …”

Section: Resultsmentioning

confidence: 99%

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Management of pain in children and adolescents with cerebral palsy: a systematic review

Ostojic

Paget

Morrow

2018

Develop Med Child Neuro

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“…3 Distraction techniques during the session help to relieve pain. 4 An anesthetic ointment type EMLA should be placed at the injection site 60' before injection. 5 In some difficult cases, a general anesthesia can be proposed.…”

Section: Clinical Usementioning

confidence: 99%

Botulinum Toxin in Children with Cerebral Palsy: An Update

Hareb¹,

Bertoncelli

Rosello

et al. 2019

Neuropediatrics

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Injected in a muscle, the botulinum toxin causes localized and temporary paralysis by acting on the neuromuscular synapse. Currently, it is widely prescribed for the treatment of limb spasticity in children from the age of 2 years. Combined with rehabilitation and other treatments, it helps to progress in motor learning, promotes functional progression, and delays orthopaedic degradations.Numerous randomized, placebo-controlled studies have shown efficacy in reducing spasticity, improving passive and active mobility, reducing pain, and improving upper limb comfort care. The side effects are rare and commonplace.The injection technique is accessible after specific training and practice. The indication is better evaluated by a multidisciplinary team. A precise clinical evaluation, assisted by an instrumental analysis (videography, spatiotemporal parameters, kinematics, kinetics, and electromyography), makes it possible to determine the aims of the treatment and to evaluate the outcome.The objective of this review is to present current evidence base and practices regarding the use of botulinum toxin in children with cerebral palsy.

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“…One study investigated the impact of clown interventions on pain during recurrent botulinum toxin injections in children with cerebral palsy [30]. A total of 45 children (aged 1.5-18 years) were randomized to receive either clown (n = 20) or standard care (n = 25).…”

Section: Presence Of Clown Doctors During Medical Proceduresmentioning

confidence: 99%

Healthcare Clowning: Use of Specific Complementary and Alternative Medicine for Hospitalized Children

Dionigi¹

2018

OBM Integr Complement Med

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Clowning has a varied tradition and a long history. Recently, clowns have been adopted in the medical setting with the aim of decreasing the negative emotions that can be experienced during hospitalization and medical procedures, as well as inducing positive feelings in patients, their relatives, and the hospital staff. Due to an increase in the number of clowns working in hospitals and the large amount of interest shown in utilizing this approach, an increasing number of studies have focused on testing the efficacy of this complementary and alternative strategy. Here, we provide an overview of the concept of healthcare clowning followed by a literature review of 28 randomized controlled trials (RCTs) drawn from two databases (PubMed and Google Scholar), with the aim of investigating and discussing evidence for the effects of healthcare clowning on children. The search revealed the different settings in which RCTs have been conducted: preoperative areas, during medical procedures, and during hospitalization. The search also revealed the different outcomes that were measured. In general, the results show that clown interventions are effective in decreasing negative emotions and psychological symptoms and in enhancing the well-being of patients and their relatives. Appreciation of clown interventions by healthcare staff has also increased in recent years.

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Clown-care reduces pain in children with cerebral palsy undergoing recurrent botulinum toxin injections- A quasi-randomized controlled crossover study

Cited by 38 publications

References 37 publications

Management of pain in children and adolescents with cerebral palsy: a systematic review

Management of pain in children and adolescents with cerebral palsy: a systematic review

Botulinum Toxin in Children with Cerebral Palsy: An Update

Healthcare Clowning: Use of Specific Complementary and Alternative Medicine for Hospitalized Children

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