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Evidence-Based, Implementable Motor Rehabilitation Guidelines for Individuals With Cerebral Palsy
Anthony Demont1, Michel Gedda2, Céline Lager2
1From the French National Authority for Health (A.D., M.G.), Saint-Denis; University of Paris, ECEVE (A.D., M.G.), Inserm, U1123, Paris; Occupational Therapy Clinic (C. Lager), Mouans Sartoux; ESEAN-APF Pediatric Rehabilitation Center (C. de Lattre), Nantes; Bourgès Clinic (Y.G.), Castelnau-le-lez; Société d'études et de soins pour les enfants paralysés et polymalformés (E.K.), Antony; Hôpitaux de Saint-Maurice (B.F.); ISPO France (H.C.), Lyon; Physiotherapy Clinic (Z.S.), Orléans; Neuropediatrics Department (A.I.), Hôpital Armand Trousseau, CRMR Neuromuscular Pathologies, APHP, Paris, France; Orthopedic Department (E.V.), Neuro-orthopedics Unit and Movement Analysis Center, Université Bâle, Basel, Switzerland; Fondation Paralysie Cérébrale (M.C., M.H., J.B., N.G.), Paris; Association Française de Pédiatrie Ambulatoire (P.V.), Talence; Physical and Rehabilitation Medicine Department (X.B.), Neurosciences, CHU, Toulouse; ToNIC, Toulouse NeuroImaging Center (X.B.), University of Toulouse, Inserm, UPS, Toulouse; ISIR (A.F.), Sorbonne University, Paris; Physical and Medical Rehabilitation Department (S.B.), CHRU Brest; Paediatric Physical and Medical Rehabilitation Department (S.B.), Fondation ILDYS, Brest; and University of Western Brittany (S.B.), Laboratory of Medical Information Processing, Inserm U1101, Brest, France. anthony.demont@gmail.com.
Background:
Cerebral palsy is a life-long condition that causes heterogeneous motor disorders. Motor rehabilitation interventions must be adapted to the topography of the symptoms, ambulatory capacity, and age of the individual. Current guidelines do not differentiate between the different profiles of individuals with cerebral palsy, which limits their implementation.
Objectives:
To develop evidence-based, implementable guidelines for motor rehabilitation interventions for individuals with cerebral palsy according to the age, topography of the cerebral palsy, and ambulatory capacity of the individual and to determine a level of priority for each intervention.
Methods:
We used a mixed methods design that combined a systematic review of the literature on available motor rehabilitation interventions with expert opinions. Based on the French National Authority for Health methodology, recommendations were graded as strong, conditional, or weak. Interventions were then prioritized by the experts according to both the evidence and their own opinions on relevance and implementability to provide a guide for clinicians. All recommendations were approved by experts who were independent from the working group.
Results:
Strong recommendations as first-line treatments were made for gait training, physical activities, and hand-arm bimanual intensive therapy for all children and adolescents with cerebral palsy. Moderate recommendations were made against passive joint mobilizations, muscle stretching, prolonged stretching with the limb fixed, and neurodevelopmental therapies for all children and adolescents with cerebral palsy. Strong recommendations as first-line treatments were made for gait training for all adults with cerebral palsy and moderate recommendations as moderate importance interventions for strengthening exercises and ankle-foot orthoses for motor impairment of the feet and the ankles.
Discussion:
These guidelines, which combine research evidence and expert opinions, could help individuals with cerebral palsy and their families to codetermine rehabilitation goals with health professionals, according to their preferences.
