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

BACKGROUND: Evidence 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 clinica...

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Autores principales: Faccioli, Silvia, Pagliano, Emanuela, Ferrari, Adriano, Maghini, Cristina, Siani, Maria F., Sgherri, Giada, Cappetta, Gina, Borelli, Giulia, Farella, Giuseppina M., Foscan, Maria, Viganò, Marta, Sghedoni, Silvia, Perazza, Silvia, Sassi, Silvia
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10248244/
https://www.ncbi.nlm.nih.gov/pubmed/37305763
http://dx.doi.org/10.3389/fneur.2023.1171224
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author Faccioli, Silvia
Pagliano, Emanuela
Ferrari, Adriano
Maghini, Cristina
Siani, Maria F.
Sgherri, Giada
Cappetta, Gina
Borelli, Giulia
Farella, Giuseppina M.
Foscan, Maria
Viganò, Marta
Sghedoni, Silvia
Perazza, Silvia
Sassi, Silvia
author_facet Faccioli, Silvia
Pagliano, Emanuela
Ferrari, Adriano
Maghini, Cristina
Siani, Maria F.
Sgherri, Giada
Cappetta, Gina
Borelli, Giulia
Farella, Giuseppina M.
Foscan, Maria
Viganò, Marta
Sghedoni, Silvia
Perazza, Silvia
Sassi, Silvia
author_sort Faccioli, Silvia
collection PubMed
description BACKGROUND: Evidence 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. METHODS: Guidelines 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. RESULTS: Four 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. CONCLUSION: A 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.
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spelling pubmed-102482442023-06-09 Evidence-based management and motor rehabilitation of cerebral palsy children and adolescents: a systematic review Faccioli, Silvia Pagliano, Emanuela Ferrari, Adriano Maghini, Cristina Siani, Maria F. Sgherri, Giada Cappetta, Gina Borelli, Giulia Farella, Giuseppina M. Foscan, Maria Viganò, Marta Sghedoni, Silvia Perazza, Silvia Sassi, Silvia Front Neurol Neurology BACKGROUND: Evidence 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. METHODS: Guidelines 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. RESULTS: Four 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. CONCLUSION: A 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. Frontiers Media S.A. 2023-05-25 /pmc/articles/PMC10248244/ /pubmed/37305763 http://dx.doi.org/10.3389/fneur.2023.1171224 Text en Copyright © 2023 Faccioli, Pagliano, Ferrari, Maghini, Siani, Sgherri, Cappetta, Borelli, Farella, Foscan, Viganò, Sghedoni, Perazza and Sassi. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Neurology
Faccioli, Silvia
Pagliano, Emanuela
Ferrari, Adriano
Maghini, Cristina
Siani, Maria F.
Sgherri, Giada
Cappetta, Gina
Borelli, Giulia
Farella, Giuseppina M.
Foscan, Maria
Viganò, Marta
Sghedoni, Silvia
Perazza, Silvia
Sassi, Silvia
Evidence-based management and motor rehabilitation of cerebral palsy children and adolescents: a systematic review
title Evidence-based management and motor rehabilitation of cerebral palsy children and adolescents: a systematic review
title_full Evidence-based management and motor rehabilitation of cerebral palsy children and adolescents: a systematic review
title_fullStr Evidence-based management and motor rehabilitation of cerebral palsy children and adolescents: a systematic review
title_full_unstemmed Evidence-based management and motor rehabilitation of cerebral palsy children and adolescents: a systematic review
title_short Evidence-based management and motor rehabilitation of cerebral palsy children and adolescents: a systematic review
title_sort evidence-based management and motor rehabilitation of cerebral palsy children and adolescents: a systematic review
topic Neurology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10248244/
https://www.ncbi.nlm.nih.gov/pubmed/37305763
http://dx.doi.org/10.3389/fneur.2023.1171224
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