Interventions to improve physical function for children and young people with cerebral palsy: international clinical practice guideline

Michelle Jackman, Leanne Sakzewski, Catherine Morgan, Roslyn N Boyd, Sue E Brennan, Katherine Langdon, Rachel A M Toovey, Susan Greaves, Megan Thorley, Iona Novak, Michelle Jackman, Leanne Sakzewski, Catherine Morgan, Roslyn N Boyd, Sue E Brennan, Katherine Langdon, Rachel A M Toovey, Susan Greaves, Megan Thorley, Iona Novak

Abstract

Aim: To provide recommendations for interventions to improve physical function for children and young people with cerebral palsy.

Method: An expert panel prioritized questions and patient-important outcomes. Using Grading of Recommendations Assessment, Development and Evaluation (GRADE) methods, the panel assessed the certainty of evidence and made recommendations, with international expert and consumer consultation.

Results: The guideline comprises 13 recommendations (informed by three systematic reviews, 30 randomized trials, and five before-after studies). To achieve functional goals, it is recommended that intervention includes client-chosen goals, whole-task practice within real-life settings, support to empower families, and a team approach. Age, ability, and child/family preferences need to be considered. To improve walking ability, overground walking is recommended and can be supplemented with treadmill training. Various approaches can facilitate hand use goals: bimanual therapy, constraint-induced movement therapy, goal-directed training, and cognitive approaches. For self-care, whole-task practice combined with assistive devices can increase independence and reduce caregiver burden. Participation in leisure goals can combine whole-task practice with strategies to address environmental, personal, and social barriers.

Interpretation: Intervention to improve function for children and young people with cerebral palsy needs to include client-chosen goals and whole-task practice of goals. Clinicians should consider child/family preferences, age, and ability when selecting specific interventions.

© 2021 Mac Keith Press.

References

REFERENCES

    1. Galea C, Mcintyre S, Smithers-Sheedy H, et al. Cerebral palsy trends in Australia (1995-2009): a population-based observational study. Dev Med Chil Neurol 2019; 61: 186-93.
    1. Hollung SJ, Vik T, Lydersen S, Bakken IJ, Andersen GL. Decreasing prevalence and severity of cerebral palsy in Norway among children born 1999 to 2010 concomitant with improvements in perinatal health. Eur J Paediatr Neurol 2018; 22: 814-21.
    1. Chauhan A, Singh M, Jaiswal N, Agarwal A, Sahu JK, Singh M. Prevalence of cerebral palsy in Indian children: a systematic review and meta-analysis. Ind J Pediatr 2019; 86: 1124-30.
    1. Khandaker G, Muhit M, Karim T, Smithers-Sheedy H, Novak I, Jones C, Badawi N. Epidemiology of cerebral palsy in Bangladesh: a population-based surveillance study. Dev Med Chil Neurol 2019; 61: 601-9.
    1. Rosenbaum P, Paneth N, Leviton A, et al. A report: the definition and classification of cerebral palsy April 2006. Dev Med Chil Neurol 2007; 109(Suppl): 8-14.
    1. Novak I, Hines M, Goldsmith S, Barclay R. Clinicial prognostic messages from a systematic review on cerebral palsy. Pediatrics 2012; 130: e1285-312.
    1. Jones RA, Riethmuller A, Hesketh K, Trezise J, Batterham M, Okely AD. Promoting fundamental movement skill development and physical activity in early childhood settings: a cluster randomized controlled trial. Pediatr Exerc Sci 2011; 23: 600-15.
    1. World Health Organization. International classification of functioning, disability and health: ICF. Geneva, Switzerland: World Health Organization; 2001.
    1. Rosenbaum P, Gorter JW. The ‘F-words’ in childhood disability: I swear this is how we should think! Child Care Health Dev 2012; 38: 457-63.
    1. Mastos M, Miller K, Eliasson AC, Imms C. Goal-directed training: linking theories of treatment to clinical practice for improved functional activities in daily life. Clin Rehabil 2007; 21: 47-55.
    1. Rostami HR, Malamiri RA. Effect of treatment environment on modified constraint-induced movement therapy results in children with spastic hemiplegic cerebral palsy: a randomized controlled trial. Disabil Rehabil 2012; 34: 40-4.
    1. Schünemann H, Brożek J, Guyatt G, Oxman A. GRADE handbook for grading quality of evidence and strength of recommendations. The GRADE Working Group; 2013.
    1. Alonso-Coello P, Oxman AD, Moberg J, et al. GRADE Evidence to Decision (EtD) frameworks: a systematic and transparent approach to making well informed healthcare choices. 2: clinical practice guidelines. BMJ 2016; 353: i2089.
    1. Alonso-Coello P, Schünemann HJ, Moberg J, et al. GRADE evidence to decision (EtD) frameworks: a systematic and transparent approach to making well informed healthcare choices. 1: introduction. BMJ 2016; 353: i2016.
    1. Shea BJ, Reeves BC, Wells G, et al. AMSTAR 2: a crticial appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. BMJ 2017; 358: j4008.
    1. Higgins J, Savociv J, Page M, Sterne J. A revised tool for assessing risk of bias in randomized trials (RoB 2). In: Higgins J, Thomas J, Chandler J, Cumpston M, Li T, Welch V, editors. Cochrane methods. Cochrane database of systematic reviews of interventions. Available from: Cochrane Methods; 2018.
    1. Sterne JA, Hernán MA, Reeves BC, et al. ROBINS-I: a tool for assessing risk of bias in non-ransomized studies of interventions. BMJ 2016; 355: i4919.
    1. Andrews J, Guyatt G, Oxman AD, et al. GRADE guidelines: 14. Going from evidence to recommendations: the significance and presentation of recommendations. J Clin Epidemiol 2013; 66: 719-25.
    1. Andrews JC, Schünemann HJ, Oxman AD, et al. GRADE guidelines: 15. Going from evidence to recommendation-determinants of a recommendation’s direction and strength. J Clin Epidemiol 2013; 66: 726-35.
    1. Guyatt GH, Alonso-Coello P, Schünemann HJ, et al. Guideline panels should seldom make good practice statements: guidance from the GRADE Working Group. J Clin Epidemiol 2016; 80: 3-7.
    1. Löwing K, Bexelius A, Brogren CE. Activity focused and goal directed therapy for children with cerebral palsy - do goals make a difference? Disabil Rehabil 2009; 31: 1808-16.
    1. Nijhuis BJ, Reinders-Messelink HA, de Blécourt AC, et al. Goal setting in Dutch paediatric rehabilitation. Are the needs and principal problems of children with cerebral palsy integrated into their rehabilitation goals? Clin Rehabil 2008; 22: 348-63.
    1. Darrah J, Wiart L, Magill-Evans J. Do therapists’ goals and interventions for children with cerebral palsy reflect principles in contemporary literature? Pediatr Phys Ther 2008; 20: 334-9.
    1. Palisano RJ, Snider LM, Orlin MN. Recent advances in physical and occupational therapy for children with cerebral palsy. Semin Pediatr Neurol 2004; 11: 66-77.
    1. Brandão M, Ocarino JM, Bueno KMP, Mancini MC. Hand use at home and in clinical settings by children with cerebral palsy: a qualitative study. Occup Ther Int 2015; 22: 43-50.
    1. Law M, Baptiste S, Carswell A, McColl M, Polatajko HJ, Pollock N. COPM Canadian Occupational Performance Measure. Ottowa, ON: CAOT Publications ACE; 2005.
    1. Bowman J, Mogensen L, Marsland E, Lannin N. The development, content validity and inter-rater reliability of the SMART-Goal Evaluation Method: a standardised method for evaluating clinical goals. Austral Occup Ther J 2015; 62: 420-7.
    1. Lord C, Rapley T, Marcroft C, Pearse J, Basu A. Determinants of parent-delivered therapy intervention in children with cerebral palsy: a qualitative synthesis and checklist. Child Care Health Dev 2018; 44: 659-69.
    1. Shea CH, Wulf G. Enhancing motor learning through external-focus instructions and feedback. Hum Move Sci 1999; 18: 553-71.
    1. Sigrist R, Rauter G, Riener R, Wolf P. Augmented visual, auditory, haptic, and multimodal feedback in motor learning: a review. Psychonom Bull Rev 2013; 20: 21-53.
    1. Majnemer A, Shevell M, Law M, Poulin C, Rosenbaum P. Level of motivation in mastering challenging tasks in children with cerebral palsy. Dev Med Child Neurol 2010; 52: 1120-6.
    1. Miller L, Ziviani J, Ware RS, Boyd RN. Does context matter? Mastery motivation and therapy engagement of children with cerebral palsy. Phys Occup Ther Pediatr 2016; 36: 155-70.
    1. Novak I, Cusick A, Lannin N. Occupational therapy home programs for cerebral palsy: double-blind, randomized, controlled trial. Pediatrics 2009; 124: e606-14.
    1. Zuurmond M, O’Banion D, Gladstone M, et al. Evaluating the impact of a community-based parent training programme for children with cerebral palsy in Ghana. PLoS One 2018; 13: e0202096.
    1. Wiart L, Ray L, Darrah J, Magill-Evans J. Parents’ perspectives on occupational therapy and physical therapy goals for children with cerebral palsy. Disabil Rehabil 2010; 32: 248-58.
    1. Hayles E, Jones A, Harvey D, Plummer D, Ruston S. Delivering healthcare services to children with cerebral palsy and their families: a narrative review. Health Soc Care Community 2015; 23: 242-51.
    1. Jackman M, Lannin N, Galea C, Sakzewski L, Miller L, Novak I. What is the threshold dose of upper limb training for children with cerebral palsy to improve function? A systematic review. Austral Occup Ther J 2020; 67: 269-80.
    1. Jeglinsky I, Salminen AL, Carlberg EB, Autti-Rämö I. Rehabilitation planning for children and adolescents with cerebral palsy. J Pediatr Rehabil Med 2012; 5: 203-15.
    1. Booth ATC, Buizer AI, Meyns P, Oude Lansink ILB, Steenbrink F, Krogt MM. The efficacy of functional gait training in children and young adults with cerebral palsy: a systematic review and meta-analysis. Dev Med Child Neurol 2018; 60: 866-83.
    1. Grecco LAC, Zanon N, Sampaio LMM, Oliveira CS. A comparison of treadmill training and overground walking in ambulant children with cerebral palsy: randomized controlled clinical trial. Clin Rehabil 2013; 27: 686-96.
    1. Chrysagis N, Skordilis EK, Stavrou N, Grammatopoulou E, Koutsouki D. The effect of treadmill training on gross motor function and walking speed in ambulatory adolescents with cerebral palsy: a randomized controlled trial. Am J Phys Med Rehabil 2012; 91: 747-60.
    1. Gharib NMM, Abd El-Maksoud GM, Rezk-Allah SS. Efficacy of gait traner as an adjunct to traditional physical therapy on walking performance in hemiparetic cerebral palsied children: a randomized controlled trial. Clin Rehabil 2011; 25: 924-34.
    1. Bleyenheuft Y, Arnould C, Brandao MB, Bleyenheuft C, Gordon AM. Hand and arm bimanual intensive therapy including lower extremity (HABIT-ILE) in children with unilateral spastic cerebral palsy: a randomized trial. Neurorehabil Neur Repair 2015; 29: 645-57.
    1. Bleyenheuft Y, Ebner-Karestinos D, et al. Intensive upper- and lower-extremity training for children with bilateral cerebral palsy: a quasi-randomized trial. Dev Med Chil Neurol 2017; 59: 625-33.
    1. Law MC, Darrah J, Pollock N, et al. Focus on function: a cluster, randomized controlled trial comparing child- versus context-focused intervention for young children with cerebral palsy. Dev Med Chil Neurol 2011; 53: 621-9.
    1. Kruijsen-Terpstra AJA, Ketelaar M, Verschuren O, et al. Efficacy of three therapy approaches in preschool children with cerebral palsy: a randomized controlled trial. Dev Med Child Neurol 2016; 58: 758-66.
    1. Bar-Haim S, Harries N, Nammourah I, et al. Effectiveness of motor learning coaching in children with cerebral palsy: a randomized controlled trial. Clin Rehabil 2010; 24: 1009-20.
    1. Ketelaar M, Vermeer A, Hart H, van Petegem-van Beek E, Helders PJM. Effects of a functional therapy program on motor abilities of children with cerebral palsy. Phys Ther 2001; 81: 1534-45.
    1. Hoare BJ, Wallen MA, Thorley MN, Jackman ML, Carey LM, Imms C. Constraint-induced movement therapy in children with unilateral cerebral palsy. Cochrane Database Syst Rev 2019; 4: Cd004149.
    1. Gordon AM, Schneider JA, Chinnan A, Charles JR. Efficacy of a hand-arm bimanual intensive therapy (HABIT) in children with hemiplegic cerebral palsy: a randomized control trial. Dev Med Chil Neurol 2007; 49: 830-8.
    1. Jackman M, Novak I, Lannin N, Froude E, Miller L, Galea C. Effectiveness of cognitive orientation to daily occupational performance over and above functional hand splints for children with cerebral palsy or brain injury: a randomized controlled trial. BMC Pediatr 2018; 18: 248.
    1. Figueiredo PRP, Mancini MC, Feitosa AM, et al. Hand-arm bimanual intensive therapy and daily functioning of children with bilateral cerebral palsy: a randomized controlled trial. Dev Med Chil Neurol 2020; 62: 1274-82.
    1. Cameron D, Craig T, Edwards B, Missiuna C, Schwellnus H, Polatajko HJ. Cognitive orientation to daily occupational performance (CO-OP): a new approach for children with cerebral palsy. Phys Occup Ther Pediatr 2017; 37: 183-98.
    1. Gimeno H, Brown RG, Lin JP, Cornelius V, Polatajko HJ. Cognitive approach to rehabilitation in children with hyperkinetic movement disorders post-DBS. Neurology 2019; 92: e1212-24.
    1. Cussen A, Howie L, Imms C. Looking to the future: adolescents with cerebral palsy talk about their aspirations - a narrative study. Disabil Rehabil 2012; 34: 2103-10.
    1. Shikako-Thomas K, Shevell M, Schmitz N, Lach L, Law M, Poulin C, Majnemer A. Determinants of participation in leisure activities among adolescents with cerebral palsy. Res Dev Disabil 2013; 34: 2621-34.
    1. Imms C. Children with cerebral palsy participate: a review of the literature. Disabil Rehabil 2008; 30: 1867-84.
    1. Reedman SE, Boyd RN, Trost SG, Elliott C, Sakzewski L. Efficacy of participation-focused therapy on performance of physical activity participation goals and habitual physical activity in children with cerebral palsy: a randomized controlled trial. Arch Phys Med Rehabil 2019; 100: 676-86.
    1. Anaby DR, Law M, Feldman D, Majnemer A, Avery L. The effectiveness of the Pathways and Resources for Engagement and Participation (PREP) intervention: improving participation of adolescents with physical disabilities. Dev Med Child Neurol 2018; 60: 513-9.
    1. Law M, Anaby D, Imms C, Teplicky R, Turner L. Improving the participation of youth with physical disabilities in community activities: an interrupted time series design. Austral Occup Ther J 2015; 62: 105-15.
    1. Reedman S, Boyd RN, Sakzewski L. The efficacy of interventions to increase physical activity participation of children with cerebral palsy: a systematic review and meta-analysis. Dev Med Child Neurol 2017; 59: 1011-8.
    1. Willis C, Nyquist A, Jahnsen R, Elliott C, Ullenhag A. Enabling physical activity participation for children and youth with disabilities following a goal-directed, family-centred intervention. Res Dev Disabil 2018; 77: 30-9.
    1. Heesh R, Greaves S, Sheppard L, Imms C. Daily living transactions. Children with cerebral palsy (CP) who are non-ambulant are likely to require assistance from a carer and a supportive context to complete daily routines. In Proc. 3rd Victorian allied health research conference: disability and enablement, Melbourne, Australia; 2019.
    1. Novak I, Morgan C, Fahey M, et al. State of the evidence traffic lights 2019: systematic review of interventions for preventing and treating children with cerebral palsy. Curr Neurol Neurosci Rep 2020; 20: 1-21.
    1. Damiano DL, Longo E, Carolina de Campos A, Forssberg H, Rauch A. Systematic review of clinical guidelines related to care of individuals with cerebral palsy as part of the World Health Organization efforts to develop a global package of interventions for rehabilitation. Archives of Physical Medicine and Rehabilitation 2021; 1764-1774. doi: . Online ahead of print.

Source: PubMed

スポンサーと協力者

医学的状態

薬物療法

3
購読する