Effectiveness of Treatment in Children With Cerebral Palsy

Abstract

Objective: The objective of this study was to assess the effectiveness of conservative and surgical treatment in cerebral palsy children by evaluating the Medical Research Council (MRC) grading system, modified Ashworth scale, and Barthel Activities of Daily Life (ADL) scale. Method: This prospective case series was performed using a non-probability consecutive sampling technique at the Department of Orthopedic Surgery and Traumatology, King Edward Medical University/Mayo Hospital, Lahore from October 2011 to November 2013. Two hundred children of all ages, having cerebral palsy diagnosed on history and clinical examination were enrolled in the study. Children were treated with conservative and surgical treatment. Pre- and post-treatment, all children were classified based on movement disorder (spastic, athetoid, ataxic, and mixed), parts of the body involved (paraplegic, tetraplegic, diplegic, hemiplegic, monoplegic, double hemiplegic, and triplegic), and gross motor function (GMFCS level I-IV). Their muscle power and tone were assessed using the MRC grading system and modified Ashworth scale, respectively. Assessment of disability and daily function was done by ranking disability grading and Barthel ADL, respectively. The range of motion (ROM) of each joint was assessed clinically. Children were divided based on the treatment method as non-surgical versus surgical treatment. Results: Out of a total of 200 children, the mean age of the children was 7.86±4.17year. There were 134 (67.0%) males and 66 (33.0%) female children. Classification on basis of movement disorder, body part involved, and gross motor function at three-month intervals till twelve months was performed. From the first presentation of children till the last follow-up time period, i.e., 12th month there was no change in the movement disorder (a type of CP, body parts involved, and GMFCS). The final rating of overall treatment results shows that there were 84 (42%) patients who had a poor outcome, and only 35 (17.50%) patients had a fair treatment outcome and 81 (40.50%) patients had good treatment outcomes. Conclusion: The conservative and surgical management showed no effect on movement disorder of the child although, on the final rating scale fair to good treatment outcome was observed in all children. There was an improvement in muscle power grading on the ADL, but no significant improvement was seen on the improvement of type, parts of the body involved, gross motor function classification, modified Ashworth, and ranking disability grading of the children.

Review of Sensory Integration Therapy for Children With Cerebral Palsy

“…Cerebral Palsy (CP) is a group of permanent disorders of movement and posture causing activity limitation, which is attributed to non-progressive disturbances that occur in the developing fetal or infant's brain [1]. It influences a children's mobility, eyesight, learning, and reasoning.…”

“…It can occur up to the age of two years, as the maturation of the cortex occurs at the age of two years and CP affects the brain in an immature stage. It arises in several children as a response to cerebral hypoxia, and preterm newborns are more likely to acquire CP [1]. It is a long-term physical impairment caused by upper motor neuron damage that impacts 1.5-2.5 infants per thousand live births worldwide, resulting in a global prevalence of 17 million individuals.…”

Multi-Level Fibrotomy for Pediatric Patients with Cerebral Palsy: A Cohort Study

“…CP patients usually underwent numerous surgical procedures during their lives [17]; therefore, surgical techniques and post-operative rehabilitation must be updated to improve CP patients' outcomes. Therefore, it could be helpful to find a new minimally invasive surgical technique reducing the postoperative discomfort, and accelerating the healing process and the rehabilitation processes [18].…”