Evidence-Based, Implementable Motor Rehabilitation Guidelines for Individuals With Cerebral Palsy

Abstract

Background:Cerebral palsy is a life-long condition that causes heterogeneous motor disorders. Motor rehabilitation interventions must be adapted to the topography of the symptoms, ambulatory capacity and age of the individual. Current guidelines do not differentiate between the different profiles of individuals with cerebral palsy, which limits their implementation.Objectives:To develop evidence-based, implementable guidelines for motor rehabilitation interventions for individuals with cerebral palsy according to the age, topography of the cerebral palsy and ambulatory capacity of the individual, and to determine a level of priority for each intervention.Methods:We used a mixed methods design that combined a systematic review of the literature on available motor rehabilitation interventions with expert opinions. Based on the French National Authority for Health methodology, recommendations were graded as strong, conditional or weak. Interventions were then prioritized by the experts according to both the evidence and their own opinions on relevance and implementability to provide a guide for clinicians. All recommendations were approved by experts who were independent from the working group.Results:Strong recommendations as first-line treatments were made for gait training, physical activities and hand-arm bimanual intensive therapy for all children and adolescents with cerebral palsy. Moderate recommendations were made against passive joint mobilizations, muscle stretching, prolonged stretching with the limb fixed, and neurodevelopmental therapies for all children and adolescents with cerebral palsy. Strong recommendations as first-line treatments were made for gait training for all adults with cerebral palsy and moderate recommendations as moderate importance interventions for strengthening exercises and ankle-foot orthoses for motor impairment of the feet and the ankles.Discussion:These guidelines, which combine research evidence and expert opinion, could help individuals with cerebral palsy and their families to co-determine rehabilitation goals with health professionals, according to their preferences.

Bimanual movements in children with cerebral palsy: a systematic review of instrumented assessments

“…Difficulty executing bimanual tasks is one of the greatest causes of functional impairment for these children because it impacts their participation and quality of life [ 6 – 8 ]. Furthermore, since new, innovative therapies focus on developing and training bimanual performance to improve participation in daily life activities [ 9 ], validated evaluation of bimanual movements has become crucial.…”

Brain Stimulation and Constraint Induced Movement Therapy in Children With Unilateral Cerebral Palsy: A Randomized Controlled Trial

“…1 Constraint-induced movement therapy (CIMT) has been shown to result in an improvement in bimanual performance and unimanual capacity in children with unilateral CP, however, the quality of evidence is low. 2,3 Moreover, the effect sizes are modest, with a mean difference (MD) of 5.44 Assisting Hand Assessment (AHA) units and MD ranging from 5.95 to 12.54 across various domains of the Quality of Upper Extremity Skills Test (QUEST). 2 Given these modest effect sizes, there is a need to explore additional neurorehabilitation measures like neuromodulation, in this population.…”

Effects of non-immersive virtual reality intervention on children with spastic cerebral palsy: a meta-analysis and systematic review

“…The meta-analysis by Oskoui et al 3 showed that the international prevalence rate of children with cerebral palsy was 0.21%. In China, the prevalence of CP among children younger than 7 yrs is 1.6 per 1000 children, and the estimated total number of children living with CP in China is 310,000 4 …”

“…In China, the prevalence of CP among children younger than 7 yrs is 1.6 per 1000 children, and the estimated total number of children living with CP in China is 310,000. 4 In recent decades, the neonatal mortality rate and incidence of stillbirth have decreased significantly because of the development of medicine. However, the incidence of CP has not decreased, and the proportion of patients with severe CP has increased.…”