Assessments and Interventions for Spasticity in Infants With or at High Risk for Cerebral Palsy: A Systematic Review

Area of Science:

• Pediatric Neurology
• Rehabilitation Medicine
• Developmental Pediatrics

Background:

• Spasticity is common in children with cerebral palsy, impacting motor skills and participation.
• Early identification and management are crucial for optimizing outcomes in young children.
• This review focuses on children under two years old with or at high risk for cerebral palsy.

Purpose of the Study:

• To systematically review evidence on spasticity assessments and interventions for infants with cerebral palsy.
• To integrate findings with parent preferences for management strategies.
• To identify gaps in current research and inform clinical practice.

Main Methods:

• Systematic literature search across five databases (CINAHL, EMBASE, OVID/Medline, SCOPUS, PsycINFO).
• Screening of articles using PRISMA guidelines and quality assessment with QUADAS-2, RTI, or Cochrane RoB tools.
• Online survey to gather parent preferences on spasticity assessments and interventions.

Main Results:

• Twelve articles met inclusion criteria; no high-quality assessment tools were identified for this age group.
• Six interventions were identified: botulinum toxin-A, orthotics, radial extracorporeal shock wave therapy, erythropoietic agents, medical cannabis, and homeopathy.
• Low-quality evidence supports botulinum toxin-A and radial extracorporeal shock wave therapy for short-term spasticity reduction. Parents highly value assessments and prefer non-pharmacological interventions.

Conclusions:

• Further research is essential to develop and validate reliable spasticity assessment tools for children under two years old.
• Conditional recommendations are made for botulinum toxin-A and radial extracorporeal shock wave therapy due to limited evidence.
• Parental preferences highlight the importance of non-pharmacological approaches in managing spasticity in early childhood cerebral palsy.