Although cerebral palsy (CP) is probably the most common childhood-onset disability, there are only a few evidence-based clinical practice guidelines or recommendations on methods to treat and manage this condition. A special issue of the Journal of Pediatric Rehabilitation Medicine, guest-edited by Rachel Byrne, Deborah Gaebler-Spira, Michael Green, and Heakyung Kim, in partnership with the Cerebral Palsy Foundation and published by IOS Press, assesses the state-of-the-art of the treatment of CP.

Co-guest editor Michael Green, DO, Clinical Pediatric Rehabilitation Medicine Attending at Primary Kid’s Hospital, University of Utah Health, explains, “The goal of this special issue is to deepen the conversation around CP and to enhance research and its translation into evidence-based practice to be able to improve the care and quality of life for people living with CP.”

CP is defined as a disorder of movement and posture on account of a non-progressive lesion to an immature brain. As such, children with CP may take care of movement problems which might be commonly related to spasticity. Because a standardized clinical pathway for managing spasticity doesn’t exist to guide care providers toward optimal look after individuals with CP, there is important variability within the care provided to those individuals.

There is no such thing as a single medication, intervention, or surgery that manages spasticity perfectly throughout the lifespan. Also, existing surgical and pharmacological treatments include their very own unintended effects and opposed events, which might sometimes compromise function. These challenges could be exacerbated in child-onset conditions, making spasticity management particularly difficult in individuals with CP.”

Deborah Gaebler-Spira, MD, Co-Guest Editor, Feinberg Northwestern University School of Medicine and Shirley Ryan Ability Lab/Lurie Kid’s Hospital, Chicago

Co-guest editor Heakyung Kim, MD, Department of Physical Medicine & Rehabilitation, UT Southwestern, Dallas, notes, “Given the shortage of systematically collected data, it is amazingly vital for clinicians to contemplate experts’ experiences and rationales regarding enteral baclofen use when choosing their interventions. For this special issue, we invited three experts on spasticity management to share their experiences and rationales and present a balanced view: one to debate the mechanisms and methods of baclofen as a treatment of spasticity, a second to debate the cons of this medication, and a 3rd to share the professionals of using baclofen as a treatment for spasticity.”

Featured articles

In “Is baclofen the least worst option for spasticity management in children?” Joline Brandenburg, MD, Department of Physical Medicine and Rehabilitation & Department of Pediatric and Adolescent Medicine, Mayo Clinic College of Medicine, assesses the usage of baclofen for spasticity management in children and discusses approaches to using other medications as first-line treatment options.

“In my practice, other medications for spasticity management are sometimes used prior to initiating baclofen. In this text, I discuss the approaches I absorb medication selection that incorporate spasticity severity, patient goals, and medicine side effect profiles,” Dr. Brandenburg explains.

The article “Spasticity-related pain in children/adolescents with cerebral palsy. Part 2: IncobotulinumtoxinA efficacy results from a pooled evaluation” indicates that injections with incobotulinumtoxinA could bring considerable profit to children/adolescents with spasticity by reducing spasticity-related pain (SRP).

In keeping with lead investigator Florian Heinen, MD, Division of Paediatric Neurology and Developmental Medicine and LMU Center for Children with Medical Complexity, Dr. von Hauner Kid’s Hospital, Ludwig Maximilian University of Munich: “Botulinum neurotoxinA (BoNT-A) is really helpful and its use established to alleviate CP-related spasticity in children, and it has demonstrated efficacy for improving muscle tone and helping patients achieve individualized goals of motor function. There’s less evidence available regarding the usage of BoNT-A formulations for the control of SRP, especially in children/adolescents. While the outcomes of our evaluation are promising for treatment of SRP, further research is warranted.”

In “Reliability and discriminant validity of the quantitative timed up and go in typically developing children and kids with cerebral palsy GMFCS levels I-II,” researchers examine the reliability and discriminant validity of the Quantitative Timed up and Go (QTUG) wearable sensor technology in typically developing children and kids with CP.

Lead investigator Andrea Fergus, PhD, DPT/TDPT, Shenandoah University Division of Physical Therapy, points out that “the deficits in motor performance and functional mobility observed in children with CP, gait disorders specifically, are related to activity restrictions and lower levels of participation across multiple life domains. The outcomes of our study show that the QTUG is a clinically feasible, reliable tool. We offer preliminary evidence that the QTUG can discriminate between children on several of the gait parameters throughout the TUG.”

In children with CP, neurodevelopmental therapy (NDT) is probably the most widely used treatment approach aimed toward maximizing the kid’s potential to enhance motor functions while stopping musculoskeletal complications. “Effect of the Cognitive Orientation to every day Occupational Performance (CO-OP) approach for youngsters with cerebral palsy: A randomized controlled trial” details two specific treatment approaches. Gamze Ekici, PhD and Zeynep Kolit, MSc, Department of Occupational Therapy, Faculty of Health Sciences, Hacettepe University, Ankara, arrange a randomized trial to analyze the efficacy of NDT with and without the Cognitive Orientation to every day Occupational Performance (CO-OP) approach.

“This study clearly shows that the gains after the treatment increased with the addition of the CO-OP approach in children who take the NDT approach. Thus, the CO-OP approach supports skill acquisition by improving kid’s performance levels, that are vital to perform their every day occupations,” the authors report.

Other articles on this special CP issue cover the next topics:

• The challenge point framework
• Bimanual task practice
• Use of the Computer-Based instrument for Low motor Language Testing in Canada
• Aspects related to intrathecal baclofen pump explants
• Effectiveness of intrathecal morphine following selective dorsal rhizotomy
• Treatment with trihexyphenidyl
• Outpatient hospital utilization after single event multi-level surgery
• Effects of a balance board on the balance parameters in children with spastic CP
• Use of shear wave elastography to investigate the muscle structure
• Vitamin D levels
• Hematological and biochemical parameters
• Use of music
• Obesity
• Burnout amongst informal caregivers
• Gross Motor Function Classification System levels in a low-resource setting
• Racial disparities
• Classification systems in Japan

JPRM Editor-in-Chief Elaine Pico, MD, UCSF Benioff Kid’s Hospital Oakland writes: “We established the annual JPRM CP special issue in 2019, and it has change into a vital resource nationally and internationally for all team members who take part in the care of those with this condition. Our managing editor Sara Tinsley and I work year-round with our special guest editors, and I’m particularly happy with every issue. We have now treatments for CP but no cures; due to this fact, all of the research we’ve got is targeted on higher outcomes for people with spasticity-related challenges. This special issue comprises a big collection of rigorously evaluated research in the sector of CP that may be a must read for anyone who treats this condition.”

The Journal of Pediatric Rehabilitation Medicine is partnering with the Cerebral Palsy Foundation in its efforts to offer stakeholders within the treatment and management of CP the facility needed to affect the research process and resulting outcomes.

Rachel Byrne, PT, Executive Director, Cerebral Palsy Foundation, Latest York City, NY, USA, and co-guest editor of this special issue comments, “We’re proud to partner with the Journal of Pediatric Rehabilitation Medicine. Our goal is to work closely with leaders, to develop, share, invest and supply infrastructure to otherwise underfunded areas. The Foundation uses proven models of implementation and developed research agendas to support deep systems change. Greater than ever, there’s an urgent need for dialogue about inclusion of people with disabilities in research, medicine and improving healthcare systems. Implementation potential, with translation, education and dissemination will probably be key to a really engaged process between stakeholders and researchers.”