This resource from the website Current Neurology and Neuroscience Reports, summarises the best available evidence-based interventions for preventing and managing cerebral palsy.
Synopsis
Cerebral Palsy Treatments and Therapies: What Does the Evidence Say?
Families and clinicians have many choices when considering therapies, treatments and supports for children with cerebral palsy (CP). However, it can be difficult to know which interventions are supported by research evidence, which are still emerging, and which may not be effective.
Novak et al. (2020) reviewed the best available evidence on interventions for preventing and treating CP. The study updated earlier evidence summaries and used the Evidence Alert Traffic Light System to help classify interventions according to the strength and quality of evidence.
The Evidence Alert Traffic Light System uses three broad categories:
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Green light means “do it”, because evidence supports the intervention.
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Yellow light means “measure outcomes”, because the evidence is promising, unclear, limited or mixed.
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Red light means “do not do it”, because evidence suggests the intervention is ineffective or may cause harm.
The review identified a range of interventions supported by evidence, depending on the child’s goals and needs. Examples included:
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improving movement and everyday skills: goal-directed training, task-specific training, bimanual training, constraint-induced movement therapy, mobility training and home programmes
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improving strength and fitness: strength training, fitness training and treadmill training
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managing muscle tightness and contractures: botulinum toxin, casting, intrathecal baclofen and selective dorsal rhizotomy, when appropriate
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protecting hip health: regular hip surveillance
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supporting feeding and swallowing: oral sensorimotor interventions and functional chewing training in selected situations
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supporting learning and participation: literacy interventions, environmental enrichment and participation-focused approaches.
The review also looked at strategies to prevent CP. It found strong evidence for interventions including antenatal corticosteroids, magnesium sulfate, caffeine for some preterm infants, and therapeutic hypothermia for some babies with neonatal encephalopathy.
The review found that some interventions had limited, mixed or no evidence for improving movement or function. Examples included passive or non-task-specific approaches such as craniosacral therapy, hyperbaric oxygen therapy and traditional passive neurodevelopmental therapy.
A major message from the review is that children with CP are more likely to benefit from interventions that are active, goal-focused and based on practising real-life activities. The best choice will depend on the child’s individual goals, abilities and needs.
The review summarised evidence available up to 2019, so newer research may have emerged since it was published. Families should discuss treatment choices with their healthcare team and consider the most up-to-date evidence alongside their child’s goals and preferences.