Evaluation of stress and pain in young children with cerebral palsy during early developmental intervention programs:
Xiaoke Zhao1, Mengying Chen, Senjie Du
1From the Rehabilitation Department (XZ, SD, HL) and Department of Healthcare (MC, XL), Nanjing Children's Hospital Affiliated to Nanjing Medical University, Nanjing, China.
Insights
Early developmental intervention programs cause pain and stress in young children with cerebral palsy. Assessments using the Face, Legs, Activity, Cry, Consolability Scale and salivary cortisol showed significant pain responses to treatments.
Area of Science:
- Pediatric rehabilitation
- Neuroscience
- Pain management
Background:
- Cerebral palsy (CP) affects motor function in children.
- Early intervention programs are crucial for managing CP.
- Assessing pain and stress in young children with CP during interventions is challenging.
Purpose of the Study:
- To evaluate pain, stress, and pain sensitivity in young children with CP during early developmental intervention.
- To utilize the Face, Legs, Activity, Cry, Consolability (FLACC) Scale, salivary cortisol, and withdrawal reflex thresholds for pain assessment.
Main Methods:
- 40 children with CP (age 1-4 years) participated in 3-week intervention programs.
- Interventions included neurodevelopmental treatment, neuromuscular electrical stimulation, occupational therapy, head acupuncture, and Chinese traditional manipulation.
- Pain was assessed using the FLACC Scale, salivary cortisol levels (pre- and post-treatment), and von Frey hair mechanical stimulation for withdrawal reflex thresholds.
Main Results:
- All intervention programs induced some level of pain, with head acupuncture causing the most.
- Salivary cortisol levels significantly increased after head acupuncture, neurodevelopmental treatment, neuromuscular electrical stimulation, and Chinese traditional manipulation.
- No significant changes in withdrawal reflex thresholds were observed, indicating no change in pain sensitivity.
Conclusions:
- Early developmental intervention programs for young children with cerebral palsy can cause pain and stress.
- The FLACC Scale and salivary cortisol are sensitive indicators of pain and stress in this population.
- Further research may explore less painful intervention modifications.
Objective:
The aim of this study was to use the Face, Legs, Activity, Cry, Consolability Scale; salivary cortisol levels; and withdrawal reflex thresholds to assess pain, stress, and pain sensitivity in young children with cerebral palsy during early developmental intervention programs.
Design:
A total of 40 children with cerebral palsy (age range, 1-4 yrs) participated in the early intervention programs, which included neurodevelopmental treatment, neuromuscular electrical stimulation, occupational therapy, head acupuncture, and Chinese traditional manipulation five times per week for 3 wks. The Face, Legs, Activity, Cry, Consolability Scale was applied during the course of each treatment, and salivary cortisol samples were obtained from each child 10 mins before and 10 mins after each treatment. Withdrawal reflex thresholds were assessed via mechanical stimulation of the foot with von Frey hairs.
Results:
All treatment programs caused some degree of pain. In descending order, the extents of the pain caused by each treatment were head acupuncture, neurodevelopmental treatment, neuromuscular electrical stimulation, Chinese traditional manipulation, and occupational therapy. There were statistically significant increases in salivary cortisol levels after the head acupuncture (P < 0.001), neurodevelopmental treatment (P < 0.001), neuromuscular electrical stimulation (P < 0.001), and Chinese traditional manipulation (P < 0.001) treatments. No significant changes were found in the withdrawal reflex thresholds during the study (P > 0.05).
Conclusions:
The results of this study demonstrate that early developmental intervention programs cause pain and stress in young children with cerebral palsy.
