Prevention of hip displacement in children with cerebral palsy: a systematic review

Miller, Stacey; Juricic, Maria; Hesketh, Kim; McLean, Lynore J; Magnuson, Sonja; Gasior, Sherylin; Schaeffer, Emily K.; O’Donnell, Maureen; Mulpuri, Kishore

doi:10.1111/dmcn.13480

Cited by 49 publications

(60 citation statements)

References 68 publications

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“…This paper reports purely on the best available evidence, coded using the GRADE framework. We observe that interventions in isolation (including botulinum toxin, intrathecal baclofen, selective dorsal rhizotomy, obturator nerve blocks, positioning, and bracing) have small effect sizes for preventing hip migration [145,147]. In contrast, important clues arise from longitudinal population-based studies in Sweden, which have shown that comprehensive multidisciplinary intervention (including botulinum toxin, weight-bearing, motor training, and orthopedic surgery) at the right time and the right dose can prevent hip dislocation [260].…”

Section: Hip Surveillancementioning

confidence: 98%

State of the Evidence Traffic Lights 2019: Systematic Review of Interventions for Preventing and Treating Children with Cerebral Palsy

Novak

Morgan

Fahey

et al. 2020

Curr Neurol Neurosci Rep

609

611

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Purpose of Review Cerebral palsy is the most common physical disability of childhood, but the rate is falling, and severity is lessening. We conducted a systematic overview of best available evidence (2012-2019), appraising evidence using GRADE and the Evidence Alert Traffic Light System and then aggregated the new findings with our previous 2013 findings. This article summarizes the best available evidence interventions for preventing and managing cerebral palsy in 2019. Recent Findings Effective prevention strategies include antenatal corticosteroids, magnesium sulfate, caffeine, and neonatal hypothermia. Effective allied health interventions include acceptance and commitment therapy, action observations, bimanual training, casting, constraint-induced movement therapy, environmental enrichment, fitness training, goal-directed training, hippotherapy, home programs, literacy interventions, mobility training, oral sensorimotor, oral sensorimotor plus electrical stimulation, pressure care, stepping stones triple P, strength training, task-specific training, treadmill training, partial body weight support treadmill training, and weight-bearing. Effective medical and surgical interventions include anti-convulsants, bisphosphonates, botulinum toxin, botulinum toxin plus occupational therapy, botulinum toxin plus casting, diazepam, dentistry, hip surveillance, intrathecal baclofen, scoliosis correction, selective dorsal rhizotomy, and umbilical cord blood cell therapy. Summary We have provided guidance about what works and what does not to inform decision-making, and highlighted areas for more research.

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Section: Hip Surveillancementioning

confidence: 98%

State of the Evidence Traffic Lights 2019: Systematic Review of Interventions for Preventing and Treating Children with Cerebral Palsy

Novak

Morgan

Fahey

et al. 2020

Curr Neurol Neurosci Rep

609

611

View full text Add to dashboard Cite

show abstract

“…Understandably, improvements over a long time period are mixed with natural development and a combination of other treatment modalities. According to a recent systematic review, single or repeated BTXA treatments, either alone or combined with bracing, appeared to decelerate but not to prevent hip displacement [133]. Orthopedic surgery is still important for the prevention and reconstruction of hip dislocation, and to correct and stabilize scoliosis and foot deformities [131].…”

Section: Lessons Learned From the Repeated Treatment Studiesmentioning

confidence: 99%

Over 25 Years of Pediatric Botulinum Toxin Treatments: What Have We Learned from Injection Techniques, Doses, Dilutions, and Recovery of Repeated Injections?

Sätilä

2020

Toxins

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Botulinum toxin type A (BTXA) has been used for over 25 years in the management of pediatric lower and upper limb hypertonia, with the first reports in 1993. The most common indication is the injection of the triceps surae muscle for the correction of spastic equinus gait in children with cerebral palsy. The upper limb injection goals include improvements in function, better positioning of the arm, and facilitating the ease of care. Neurotoxin type A is the most widely used serotype in the pediatric population. After being injected into muscle, the release of acetylcholine at cholinergic nerve endings is blocked, and a temporary denervation and atrophy ensues. Targeting the correct muscle close to the neuromuscular junctions is considered essential and localization techniques have developed over time. However, each technique has its own limitations. The role of BTXA is flexible, but limited by the temporary mode of action as a focal spasticity treatment and the restrictions on the total dose deliverable per visit. As a mode of treatment, repeated BTXA injections are needed. This literature reviewed BTXA injection techniques, doses and dilutions, the recovery of muscles and the impact of repeated injections, with a focus on the pediatric population. Suggestions for future studies are also discussed.

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“…A recent systematic review into interventions that may prevent hip dysplasia in CP did not find SDR to have either a positive or negative effect. 54 When hip surgery is required in a child who is otherwise eligible for SDR, timing of such intervention is discussed later in this review.…”

Section: Outcomes Of Sdrmentioning

confidence: 99%

“…Currently, it is unclear what effect, if any, SDR has on neuromuscular hip dysplasia. 54 However, it is clear that once hip dislocation is established, pain is common and reconstructive options are limited, hence the relative priority this should be given over SDR. Simultaneous SDR and hip reconstruction should be avoided, as one operation will restrict the rehabilitation required by the other.…”

Section: Sdr Within a Multi-disciplinary Multi-modal Approachmentioning

confidence: 99%

Selective dorsal rhizotomy in ambulant children with cerebral palsy

Wang

Munger

Chen

et al. 2018

Journal of Children's Orthopaedics

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Abstract:BackgroundSelective dorsal rhizotomy (SDR) is a surgical procedure for treating spasticity in ambulant children with cerebral palsy (CP). However, controversies remain regarding indications, techniques and outcomes.Current evidence summaryBecause SDR is an irreversible procedure, careful patient selection, a multi-disciplinary approach in assessment and management and division of the appropriate proportion of dorsal rootlets are felt to be paramount for maximizing safety. Reliable evidence exists that SDR consistently reduces spasticity, in a predictable manner and to a substantial degree. However, functional improvements are small in the short-term with long-term benefits difficult to assess.Future outlookThere is a need for high-quality studies utilizing long-term functional outcomes and well-matched control groups. Collaborative, multicentre efforts are required to further define the role of SDR as part of the management paradigm in maximizing physical function in spastic CP.

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Prevention of hip displacement in children with cerebral palsy: a systematic review

Cited by 49 publications

References 68 publications

State of the Evidence Traffic Lights 2019: Systematic Review of Interventions for Preventing and Treating Children with Cerebral Palsy

State of the Evidence Traffic Lights 2019: Systematic Review of Interventions for Preventing and Treating Children with Cerebral Palsy

Over 25 Years of Pediatric Botulinum Toxin Treatments: What Have We Learned from Injection Techniques, Doses, Dilutions, and Recovery of Repeated Injections?

Selective dorsal rhizotomy in ambulant children with cerebral palsy

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