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

doi:10.1111/dmcn.15055

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

Dev Med Child Neurol. 2022 May;64(5):536-549. doi: 10.1111/dmcn.15055. Epub 2021 Sep 21.

Authors

Michelle Jackman^{1

2}, Leanne Sakzewski¹, Catherine Morgan³, Roslyn N Boyd¹, Sue E Brennan⁴, Katherine Langdon⁵, Rachel A M Toovey⁶, Susan Greaves⁷, Megan Thorley⁸, Iona Novak^{3

9}

Affiliations

¹ Queensland Cerebral Palsy and Rehabilitation Research Centre, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.
² John Hunter Children's Hospital, Newcastle, New South Wales, Australia.
³ Discipline of Child and Adolescent Health, Faculty of Medicine and Health, Cerebral Palsy Alliance Research Institute, The University of Sydney, Sydney, New South Wales, Australia.
⁴ School of Public Health and Preventative Medicine, Monash University, Melbourne, Victoria, Australia.
⁵ Perth Children's Hospital, Perth, Western Australia, Australia.
⁶ Physiotherapy Department, University of Melbourne, Melbourne, Victoria, Australia.
⁷ Occupational Therapy Department, Royal Children's Hospital, Melbourne, Victoria, Australia.
⁸ Queensland Paediatric Rehabilitation Service, Brisbane, Queensland, Australia.
⁹ Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.

PMID: 34549424
DOI: 10.1111/dmcn.15055

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.

Publication types

Practice Guideline

MeSH terms

Adolescent
Cerebral Palsy* / therapy
Child
Humans
Physical Therapy Modalities
Upper Extremity
Walking