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Effectiveness of Treatment in Children With Cerebral Palsy
Syed Faraz Ul Hassan Shah Gillani1, Akkad Rafique2, Muhammad Taqi3
1Orthopedic Surgery, King Edward Medical University/Mayo Hospital Lahore, Lahore, PAK.
Insights
Conservative and surgical treatments for cerebral palsy (CP) showed no significant change in movement disorder or body involvement. However, fair to good outcomes were observed, with improvements in muscle power and daily living activities.
Area of Science:
- Orthopedics
- Pediatrics
- Rehabilitation Medicine
Background:
- Cerebral palsy (CP) is a group of movement disorders due to brain damage.
- Effective treatment strategies for CP are crucial for improving children's quality of life.
Purpose of the Study:
- To evaluate the effectiveness of conservative and surgical treatments for cerebral palsy in children.
- To assess changes in motor function, muscle tone, and daily living activities post-treatment.
Main Methods:
- Prospective case series of 200 children with cerebral palsy.
- Evaluated treatments using the Medical Research Council (MRC) grading system, modified Ashworth scale, and Barthel Activities of Daily Living (ADL) scale.
- Assessed range of motion, movement disorder, body involvement, and Gross Motor Function Classification System (GMFCS) levels pre- and post-treatment.
Main Results:
- No significant changes were observed in movement disorder type, body parts involved, or GMFCS levels over 12 months.
- Muscle power grading showed improvement, alongside improvements in Barthel ADL scores.
- Overall treatment outcomes were rated as poor in 42%, fair in 17.5%, and good in 40.5% of children.
Conclusions:
- Conservative and surgical management did not alter the fundamental movement disorder in cerebral palsy.
- Fair to good treatment outcomes were achieved, with notable improvements in muscle strength and daily functioning.
- Further research may explore combined or novel therapeutic approaches to enhance CP management.
Objective:
The objective of this study was to assess the effectiveness of conservative and surgical treatment in cerebral palsy children by evaluating the Medical Research Council (MRC) grading system, modified Ashworth scale, and Barthel Activities of Daily Life (ADL) scale.
Method:
This prospective case series was performed using a non-probability consecutive sampling technique at the Department of Orthopedic Surgery and Traumatology, King Edward Medical University/Mayo Hospital, Lahore from October 2011 to November 2013. Two hundred children of all ages, having cerebral palsy diagnosed on history and clinical examination were enrolled in the study. Children were treated with conservative and surgical treatment. Pre- and post-treatment, all children were classified based on movement disorder (spastic, athetoid, ataxic, and mixed), parts of the body involved (paraplegic, tetraplegic, diplegic, hemiplegic, monoplegic, double hemiplegic, and triplegic), and gross motor function (GMFCS level I-IV). Their muscle power and tone were assessed using the MRC grading system and modified Ashworth scale, respectively. Assessment of disability and daily function was done by ranking disability grading and Barthel ADL, respectively. The range of motion (ROM) of each joint was assessed clinically. Children were divided based on the treatment method as non-surgical versus surgical treatment.
Results:
Out of a total of 200 children, the mean age of the children was 7.86±4.17year. There were 134 (67.0%) males and 66 (33.0%) female children. Classification on basis of movement disorder, body part involved, and gross motor function at three-month intervals till twelve months was performed. From the first presentation of children till the last follow-up time period, i.e., 12th month there was no change in the movement disorder (a type of CP, body parts involved, and GMFCS). The final rating of overall treatment results shows that there were 84 (42%) patients who had a poor outcome, and only 35 (17.50%) patients had a fair treatment outcome and 81 (40.50%) patients had good treatment outcomes. Conclusion: The conservative and surgical management showed no effect on movement disorder of the child although, on the final rating scale fair to good treatment outcome was observed in all children. There was an improvement in muscle power grading on the ADL, but no significant improvement was seen on the improvement of type, parts of the body involved, gross motor function classification, modified Ashworth, and ranking disability grading of the children.
