Informing evidence‐based clinical practice guidelines for children with cerebral palsy at risk of osteoporosis: a systematic review

Abstract

Evidence-based clinical practice guidelines were created outlining the suggested role of weight-bearing activities, vitamin D and calcium supplementation, and bisphosphonate use for children with CP with low BMD at risk of fragility fractures.

Understanding frames: A qualitative study of young people's experiences of using standing frames as part of postural management for cerebral palsy

“…For example, although using a standing frame to support hip joint development has some scant evidence, more research is needed for guidance on positioning and duration and frequency of standing (Bush et al, 2010). Furthermore, a systematic review suggests that standing frame recommendations for osteoporosis prevention cannot be supported (Fehlings et al, 2012) due to conflicting findings, small sample sizes, short study durations, and variability in weight bearing in the studies available. Young people report that standing frames are primarily useful for body structure and function.…”

Understanding frames: A UK survey of parents and professionals regarding the use of standing frames for children with cerebral palsy

“…Despite these, standing frames are part of accepted practice in the UK in children with CP GMFCS IV and V. Professionals have opinions informed by clinical experience; however, there is little research evidence to confirm whether standing frames are beneficial or cause harm. Recent systematic reviews (Bush et al , 2010; Fehlings et al, 2012; Paleg, Smith, and Glickman, 2013) have demonstrated limited and conflicting evidence for their benefit with respect to body structure and function. Although the most recent review (Paleg, Smith, and Glickman, 2013) claimed a positive effect on BMD, hip stability, and range of movement at the hip, knee, and ankle with variable duration of standing frame use, Fehlings et al (2012) found no such evidence.…”

“…Recent systematic reviews (Bush et al , 2010; Fehlings et al, 2012; Paleg, Smith, and Glickman, 2013) have demonstrated limited and conflicting evidence for their benefit with respect to body structure and function. Although the most recent review (Paleg, Smith, and Glickman, 2013) claimed a positive effect on BMD, hip stability, and range of movement at the hip, knee, and ankle with variable duration of standing frame use, Fehlings et al (2012) found no such evidence. A consensus statement acknowledged the limited evidence (Gericke, 2006) but still recommended that standing frames be used from age 12 months in children with CP and GMFCS IV and V (Gericke, 2006).…”

Bone Metabolism in Cerebral Palsy and the Effect of Light-Emitting Diode (Led) Irradiation

“…But a method of treatment for bone fragility has not been established. 3) Bone metabolism markers, as well as osteogenesis and bone resorption markers, tended to decrease markedly at around ages 8 and 15 in seriously disabled children. It is interesting that the decrease around 8 years old would be related to the stage of a fracture.…”