Global InformationManagement of cerebral palsy information
Over time, the approach to cerebral palsy management has shifted away from narrow attempts to fix individual physical problems – such as spasticity in a particular limb – to making such treatments part of a larger goal of maximizing the person's independence and community engagement.[1]: 886 Much of childhood therapy is aimed at improving gait and walking. Approximately 60% of people with CP are able to walk independently or with aids at adulthood.[2] However, the evidence base for the effectiveness of intervention programs reflecting the philosophy of independence has not yet caught up: effective interventions for body structures and functions have a strong evidence base, but evidence is lacking for effective interventions targeted toward participation, environment, or personal factors.[1] There is also no good evidence to show that an intervention that is effective at the body-specific level will result in an improvement at the activity level, or vice versa.[1] Although such cross-over benefit might happen, not enough high-quality studies have been done to demonstrate it.[1]
Because cerebral palsy has "varying severity and complexity" across the lifespan,[3] it can be considered a collection of conditions for management purposes.[4] A multidisciplinary approach for cerebral palsy management is recommended,[3] focusing on "maximising individual function, choice and independence" in line with the International Classification of Functioning, Disability and Health's goals.[5] The team may include a paediatrician, a health visitor, a social worker, a physiotherapist, an orthotist, a speech and language therapist, an occupational therapist, a teacher specialising in helping children with visual impairment, an educational psychologist, an orthopaedic surgeon, a neurologist and a neurosurgeon.[6]
Various forms of therapy are available to people living with cerebral palsy as well as caregivers and parents. Treatment may include one or more of the following: physical therapy; occupational therapy; speech therapy; water therapy; drugs to control seizures, alleviate pain, or relax muscle spasms (e.g. benzodiazepines); surgery to correct anatomical abnormalities or release tight muscles; braces and other orthotic devices; rolling walkers; and communication aids such as computers with attached voice synthesisers.[citation needed] A Cochrane review published in 2004 found a trend toward benefit of speech and language therapy for children with cerebral palsy, but noted the need for high quality research.[7] A 2013 systematic review found that many of the therapies used to treat CP have no good evidence base; the treatments with the best evidence are medications (anticonvulsants, botulinum toxin, bisphosphonates, diazepam), therapy (bimanual training, casting, constraint-induced movement therapy, context-focused therapy, fitness training, goal-directed training, hip surveillance, home programmes, occupational therapy after botulinum toxin, pressure care) and surgery (selective dorsal rhizotomy).[1]
- ^ a b c d e Novak I, McIntyre S, Morgan C, Campbell L, Dark L, Morton N, et al. (October 2013). "A systematic review of interventions for children with cerebral palsy: state of the evidence". Developmental Medicine and Child Neurology. 55 (10): 885–910. doi:10.1111/dmcn.12246. PMID 23962350. S2CID 1658072.
- ^ McGinley JL, Pogrebnoy D, Morgan P (2014). "Mobility in Ambulant Adults with Cerebral Palsy — Challenges for the Future". In Švraka E (ed.). Cerebral Palsy - Challenges for the Future. doi:10.5772/58344. ISBN 978-953-51-1234-1. S2CID 19351338.
- ^ a b Trabacca A, Vespino T, Di Liddo A, Russo L (September 2016). "Multidisciplinary rehabilitation for patients with cerebral palsy: improving long-term care". Journal of Multidisciplinary Healthcare. 9: 455–462. doi:10.2147/JMDH.S88782. PMC 5036581. PMID 27703369.
- ^ Cite error: The named reference
Lungu_2016was invoked but never defined (see the help page). - ^ National Guideline Alliance (UK) (January 2017). Cerebral Palsy in Under 25s: Assessment and Management (PDF). London: National Institute for Health and Care Excellence (UK). ISBN 978-1-4731-2272-7. Retrieved 5 February 2017.
- ^ "Cerebral palsy - Treatment". www.nhs.uk. NHS Choices. 15 March 2017. Retrieved 6 February 2017.
- ^ Pennington L, Goldbart J, Marshall J (2004). "Speech and language therapy to improve the communication skills of children with cerebral palsy". The Cochrane Database of Systematic Reviews. 2004 (2): CD003466. doi:10.1002/14651858.CD003466.pub2. PMC 8407241. PMID 15106204.
