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Published on: February 2, 2024
Preventing deformities in paediatric cerebral palsy in poorly-resourced areas: A scoping review
Shayne R van Aswegen1, Mark Richards1, Brenda Morrow1
1Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
Insights
Developing home-based routines is crucial for managing musculoskeletal complications in children with severe cerebral palsy (CP) in resource-limited settings. Evidence supports caregiver involvement and integrated daily programs for effective prevention.
Area of Science:
- Pediatric Rehabilitation
- Orthopedics
- Global Health
Background:
- Managing children with cerebral palsy (CP) in resource-limited settings (RLSs) presents significant challenges, particularly for those with severe functional limitations.
- Unaddressed orthopedic complications can further impair functional capacity in these children.
- Scarcity of rehabilitation expertise necessitates primary healthcare worker and caregiver-led interventions.
Purpose of the Study:
- To review evidence on programs and interventions mitigating musculoskeletal (MSK) complications in children with severe CP.
- To propose recommendations for a home-based program suitable for RLSs.
Main Methods:
- Searched scientific databases and professional websites for studies and reports on interventions for children (0-18 years) with severe CP.
- Included guidelines and programs focused on preventing MSK complications.
- Excluded surgical, pharmacological, and advanced/expensive technological interventions.
Main Results:
- Included 57 studies/reports. Found low-grade evidence for 24-hour postural management, supported standing, sustained stretching, and splinting.
- Caregiver training, support, and integration into daily routines are key for successful implementation.
Conclusions:
- Limited clinical guidelines and evidence exist for caregiver-delivered interventions to reduce MSK complications in severe CP.
- Weak recommendations can currently be made.
- Context-specific, home-based intervention programs are needed for children with CP in RLSs.
Background:
Managing children with cerebral palsy (CP) in poorly-resourced contexts, especially those with greater functional limitations, is challenging. Unmitigated orthopaedic complications can further restrict already compromised functional capacity. Where rehabilitation skills and knowledge are scarce, primary healthcare worker- and caregiver-implemented routines are warranted. The essential elements of a home-based routine to mitigate musculoskeletal (MSK) complications in children with severe CP in resource-limited settings (RLSs) have not been determined.
Objectives:
To summarise the evidence for programmes and interventions that mitigate MSK complications in children with severe CP and make recommendations for a programme suited to RLSs.
Method:
Scientific databases and professional websites were searched for studies and reports describing guidelines, interventions or programmes for children aged 0-18 years with severe, partially- or non-ambulant CP, that included aims for the prevention of MSK complications. Articles reporting on surgical, pharmacological and advanced or expensive technological interventions were excluded.
Results:
A total of 57 studies or reports were included in the review. Low-grade evidence exists for 24-hour postural management (24-h PM), supported standing, sustained stretching and splinting to mitigate MSK complications in children with CP. Caregiver training and support, and integration of the programme into daily routines were identified as important components for successful implementation.
Conclusion:
Clinical guidelines and evidence that support caregiver-delivered interventions to reduce MSK complications in children with severe CP are limited, and only weak recommendations can be made.
Clinical Implications:
There is a need for context-specific, home-based intervention programmes to prevent MSK complications in children with CP in RLSs.
