Management of motor problems in cerebral palsy: A critical update for the clinician

• Published in: European journal of paediatric neurology Vol. 13; no. 5; pp. 387 - 396
• Main Author: Papavasiliou, Antigone S
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.09.2009
• Subjects: Cerebral Palsy - complications; Cerebral Palsy - drug therapy; Cerebral Palsy - rehabilitation; Cerebral Palsy - therapy; Cerebral palsy treatment; Child; Complementary Therapies; Humans; Management; Motor problems; Neurology; Pediatrics; Physical Therapy Modalities; Motor problems; Cerebral palsy treatment; Management
• ISSN: 1090-3798; 1532-2130
• DOI: 10.1016/j.ejpn.2008.07.009

Abstract Currently there is no specific treatment for the brain insults leading to motor dysfunction in cerebral palsy. The available symptomatic therapeutic options place cerebral palsy among the costliest chronic childhood conditions. Therefore, it is necessary to make well-informed decisions in an effort to match cost-effectiveness with patient and family needs. This presentation aims to analyze the efficacy of rehabilitation therapy, orthoses, oral medications, botulinum toxin, intrathecal baclofen, complementary or alternative treatments and discuss guidelines for a goal oriented approach. Despite insufficient reporting of trials, physiotherapy has shifted from traditional to goal oriented approaches, based on principles of motor learning, strength and fitness training. Correct choice and use of orthoses is stressed, yet evidence from primary studies is limited. Pharmacological treatments of spasticity (oral agents, botulinum toxin, intrathecal baclofen) may be alternatives or supplements to orthopaedic surgery. There is evidence that botulinum toxin combined with conservative treatments reduces the number of complex orthopaedic interventions. Intrathecal baclofen effectively reduces spasticity; criteria describing the ideal candidate are needed. Complementary or alternative treatment use is widespread; research needs to determine what factors make these modalities desirable and effective in cerebral palsy. It is concluded that the introduction of new therapies facilitates an individualized management plan. Multimodal treatment is optimized with a multidisciplinary team. Outcome measurement according to the World Health Organization's new International Classification of Functioning, Disability and Health is emphasized.