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

Abstract

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.

Reflexão sobre práticas centradas na família a partir da perspectiva de estudantes de fisioterapia, terapia ocupacional e fonoaudiologia do Sudeste de Espanha

“…Sea como fuere, en el caso del estudiantado de Fisioterapia, su principal preocupación versaba en torno a las dificultades que podría tener la familia a la hora de poner en marcha el proceso de intervención; sus preguntas se caracterizan por tener una base más clínica y se centran en las técnicas a desarrollar y que el alumnado entiende necesarias. Con ello, dicho alumnado está obviando la evidencia científica que señala la menor eficacia de muchas de esas técnicas, en las edades más tempranas, frente a la mayor eficacia de otras formas de intervención que se pueden efectuar en el entorno natural o que, precisamente, requieren la implementación en ese entorno natural, con la implicación activa del niño o la niña y sus personas cuidadoras principales (Novak et al, 2020).…”

The Effectiveness of Hippotherapy to Recover Gross Motor Function in Children with Cerebral Palsy: A Systematic Review and Meta-Analysis

“…In addition, it also showed positive improvements at the social, cognitive, and psychological levels [6]. Furthermore, several recent reviews suggested that HPT could be effective for the neurological rehabilitation of subjects with CP: Novak et al stated that HPT was a successful allied health therapy to improve muscle symmetry in subjects with CP [7]; Mendizábal Alonso [8] suggested that HPT was effective to improve postural alignment in subjects with CP; Martin-Valero et al [9] also reported benefits in the performance of the activities of daily living and quality of life; and Zadnikar and Kastrin [10] also obtained favorable results on postural balance in subjects with CP.…”

Effect of Combined Therapy of Virtual Reality and Transcranial Direct Current Stimulation in Children and Adolescents With Cerebral Palsy: A Study Protocol for a Triple-Blinded Randomized Controlled Crossover Trial

“…In addition to evidence for the benefits of different techniques for the treatment in rehabilitation of individuals with CP ( 8 – 10 ), recent studies encourage the combination of interventions and technologies as a promising approach for rehabilitation ( 11 ). Currently, few studies had investigated the effect of combined therapies in the rehabilitation of individuals with CP, though they presented some encouraging results ( 12 – 15 ).…”

“…Muszkat et al ( 11 ), suggested that the combination of therapeutic tools should be encouraged to enhance clinical effects and provide more effective and long-lasting results. In this sense, with the increasing accessibility and evolution of technology, virtual reality (VR) and transcranial direct current stimulation (tDCS) have the potential to advance the treatment of CP ( 10 ).…”