Evidence-based management and motor rehabilitation of cerebral palsy children and adolescents: a systematic review

Frontiers in Neurology

Neurology

Silvia Sghedoni¹  Giulia Borelli¹  Adriano Ferrari¹  Silvia Perazza¹  Silvia Sassi¹  Silvia Faccioli²  Giada Sgherri³  Cristina Maghini⁴  Maria Foscan⁵  Emanuela Pagliano⁵  Marta Viganò⁵  Giuseppina M. Farella⁶  Gina Cappetta⁷  Maria F. Siani⁸ 

[1] Children Rehabilitation Unit, Azienda Unità Sanitaria Locale IRCCS di Reggio Emilia, Reggio Emilia, Italy;Children Rehabilitation Unit, Azienda Unità Sanitaria Locale IRCCS di Reggio Emilia, Reggio Emilia, Italy;Ph.D. Program in Clinical and Experimental Medicine, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy;Developmental Neuroscience Clinical Department, IRCCS Fondazione Stella Maris, Pisa, Italy;Functional Rehabilitation Unit, IRCCS E. Medea, Associazione La Nostra Famiglia, Bosisio Parini, Italy;Neurodevelopmental Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy;Physical Medicine and Rehabilitation Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy;Physical Medicine and Rehabilitation Unit, Infermi Hospital, Azienda Unità Sanitaria Locale Romagna, Rimini, Italy;Physical Medicine and Rehabilitation Unit, S. Maria delle Croci Hospital, Azienda Unità Sanitaria Locale Romagna, Ravenna, Italy;

关键词: cerebral palsy;    rehabilitation;    physical therapy modalities;    occupational therapy;    patient participation;    learning;    exercise;    play and playthings;   

DOI  :  10.3389/fneur.2023.1171224

 received in 2023-02-21, accepted in 2023-04-28,  发布年份 2023

来源: Frontiers

【 摘 要 】

BackgroundEvidence regarding the management of several aspects of cerebral palsy improved in recent years. Still, discrepancies are reported in clinical practice. Italian professionals and stakeholders expressed the need of setting up updated, evidenced-based, shared statements, to address clinical practice in cerebral palsy rehabilitation. The objective of the present study was to provide an updated overview of the state of knowledge, regarding the management and motor rehabilitation of children and young people with cerebral palsy, as the framework to develop evidence-based recommendations on this topic.MethodsGuidelines and systematic reviews were searched, relative to evidence-based management and motor treatment, aimed at improving gross motor and manual function and activities, in subjects with cerebral palsy, aged 2–18 years. A systematic search according to the Patients Intervention Control Outcome framework was executed on multiple sites. Independent evaluators provided selection and quality assessment of the studies and extraction of data.ResultsFour guidelines, 43 systematic reviews, and three primary studies were included. Agreement among guidelines was reported relative to the general requirements of management and motor treatment. Considering the subject's multidimensional profile, age and developmentally appropriate activities were recommended to set individual goals and interventions. Only a few approaches were supported by high-level evidence (i.e., bimanual therapy and constraint-induced movement therapy to enhance manual performance). Several task-specific active approaches, to improve gross motor function and gait, were reported (mobility and gait training, cycling, backward gait, and treadmill), based on low-level evidence. Increasing daily physical activity and countering sedentary behavior were advised. Based on the available evidence, non-invasive brain stimulation, virtual reality, action-observation therapy, hydrotherapy, and hippotherapy might be complementary to task or goal-oriented physical therapy programs.ConclusionA multiple-disciplinary family-centered evidence-based management is recommended. All motor rehabilitation approaches to minors affected by cerebral palsy must share the following fundamental characteristics: engaging active involvement of the subject, individualized, age and developmentally appropriate, goal-directed, skill-based, and preferably intensive and time-limited, but suitable for the needs and preferences of the child or young person and their family, and feasible considering the implications for themselves and possible contextual limitations.

【 授权许可】

Unknown   
Copyright © 2023 Faccioli, Pagliano, Ferrari, Maghini, Siani, Sgherri, Cappetta, Borelli, Farella, Foscan, Viganò, Sghedoni, Perazza and Sassi.