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Journal of Physiotherapy 63 (2017) 67–75


Question: Is stretch effective for the treatment and prevention of contractures in people with neurological and non-neurological conditions? Design: A Cochrane Systematic Review with meta- analyses of randomised trials. Participants: People with or at risk of contractures. Intervention: Trials were considered for inclusion if they compared stretch to no stretch, or stretch plus co-intervention to co-intervention only. The stretch could be administered in any way. Outcome measures: The outcome of interest was joint mobility. Two sets of meta-analyses were conducted with a random-effects model: one for people with neurological conditions and the other for people with non-neurological conditions. The quality of evidence supporting the results of the two sets of meta-analyses was assessed using GRADE. Results: Eighteen studies involving 549 participants examined the effectiveness of stretch in people with neurological conditions, and provided useable data. The pooled mean difference was 2 deg (95% CI 0 to 3) favouring stretch. This was equivalent to a relative change of 2% (95% CI 0 to 3). Eighteen studies involving 865 participants examined the effectiveness of stretch in people with non-neurological conditions, and provided useable data. The pooled standardised mean difference was 0.2 SD (95% CI 0 to 0.3) favouring stretch. This translated to an absolute mean increase of 1 deg (95% CI 0 to 2) and a relative change of 1% (95% CI 0 to 2). The GRADE level of evidence was high for both sets of meta-analyses. Conclusion: Stretch does not have clinically important effects on joint mobility

Arch Phys Med Rehabil Vol 88, November 2007

Objective: To summarize and critically appraise the available evidence on exercise therapy and other types of physical therapies for patients with neuromuscular diseases (NMD). Data Sources: Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews, Medline, CINAHL, EMBASE (Rehabilitation and Physical Medicine), and reference lists of reviews and articles. Study Selection: Randomized clinical trials (RCTs), controlled clinical trials (CCTs), and other designs were included. Study participants had to have any of the following types of NMD: motoneuron diseases, disorders of the motor nerve roots or peripheral nerves, neuromuscular transmission disorders, or muscle diseases. All types of exercise therapy and other physical therapy modalities were included. Outcome measures has to be at the level of body functions, activities, or participation according to the definitions of the International Classification of Functioning, Disability and Health (ICF). Data Extraction: Two reviewers independently decided on inclusion or exclusion of articles and rated the methodologic quality of the studies included. All RCTs, CCTs, and other designs only if of sufficient methodologic quality were included in a best evidence synthesis. A level of evidence was attributed for each subgroup of NMD and each type of intervention. Data Synthesis: Initially 58 studies were included: 12 RCTs, 5 CCTs, and 41 other designs. After methodologic assessment, 19 other designs were excluded from further analysis. There is level II evidence (“likely to be effective”) for strengthening exercises in combination with aerobic exercises for patients with muscle disorders. Level III evidence (“indications of effectiveness”) was found for aerobic exercises in patients with muscle disorders and for the combination of muscle strengthening and aerobic exercises in a heterogeneous group of muscle disorders. Finally, there is level III evidence for breathing exercises for patients with myasthenia gravis and for patients with myotonic muscular dystrophy. Adverse effects of exercise therapy were negligible. Conclusions: The available evidence is limited, but relevant for clinicians. Future studies should be preferably multicentered, and use an international classification of the variables of exercise therapy and an ICF core set for NMD in order to improve comparability of results.


Purpose of Review Cerebral palsy is the most common physical disability of childhood, but the rate is falling, and severity is
lessening. We conducted a systematic overview of best available evidence (2012–2019), appraising evidence using GRADE and
the Evidence Alert Traffic Light System and then aggregated the new findings with our previous 2013 findings. This article
summarizes the best available evidence interventions for preventing and managing cerebral palsy in 2019. Recent Findings Effective prevention strategies include antenatal corticosteroids, magnesium sulfate, caffeine, and neonatal hypothermia. Effective allied health interventions include acceptance and commitment therapy, action observations, bimanual training, casting, constraint-induced movement therapy, environmental enrichment, fitness training, goal-directed training, hippotherapy, home programs, literacy interventions, mobility training, oral sensorimotor, oral sensorimotor plus electrical
stimulation, pressure care, stepping stones triple P, strength training, task-specific training, treadmill training, partial body weight support treadmill training, and weight-bearing. Effective medical and surgical interventions include anti-convulsants,
bisphosphonates, botulinum toxin, botulinum toxin plus occupational therapy, botulinum toxin plus casting, diazepam, dentistry, hip surveillance, intrathecal baclofen, scoliosis correction, selective dorsal rhizotomy, and umbilical cord blood cell therapy. Summary We have provided guidance about what works and what does not to inform decision-making, and highlighted areas for more research

The effect of different physiotherapy interventions in post-BTX-A treatment of children with cerebral palsy
K. Desloovere, J. De Cat a,b, G. Molenaers, I. Franki, E. Himpens,H. Van Waelvelde, K. Fagard, C. Van den Broeck


Aim: To distinguish the effects of different physiotherapeutic programs in a post BTX-A
regime for children with Cerebral Palsy (CP).
Design: Retrospective, controlled intervention study.
Participants and interventions: A group of 38 children (X ¼ 7y7m, GMFCS I-III, 27 bilateral, 11
unilateral CP) receiving an individually defined Neurodevelopment Treatment (NDT)
program, was matched and compared to a group of children with the same age, GMFCS and
diagnosis, receiving more conventional physiotherapy treatment. All patients received
selective tone-reduction by means of multilevel BTX-A injections and adequate follow-up
treatment, including physiotherapy.
Outcome measures: Three-dimensional gait analyses and clinical examination was performed
pre and two months post-injection. Treatment success was defined using the Goal
Attainment Scale (GAS).
Results: Both groups’ mean converted GAS scores were above 50. The average converted
GAS score was higher in the group of children receiving NDT than in the group receiving
conventional physiotherapy ( p < 0.05). In the NDT group, overall treatment success was
achieved in 76% of the goals, compared to 67% of the goals defined for the conventional
physiotherapy group. Especially for the goals based on gait analyses ( p < 0.05) and in the
group of children with bilateral CP ( p < 0.05), treatment success was higher in the NDT
Conclusion: In a post-BTX-A regime, the short-term effects of an NDT approach are more
pronouncedthan these from a conventional physiotherapy approach.

europ e an j o u r n a l of p a e d i a t r i c neurology 1 6 ( 2 0 1 2 ) 2 0 e2 8


Early detection of childhood disability is possible using clinically available tools and procedures. Earlydetection of disability enables early intervention that maximizes the child’s outcome, prevents the onsetof complications, and supports parents. In this chapter, first we summarize the best-available tools foraccurately predicting major childhood disabilities early, including autism spectrum disorder, cerebral palsy,developmental coordination disorder, fetal alcohol spectrum disorder, intellectual disability, hearing impair-ment, and visual impairment. Second, we provide an overview of the preclinical and clinical evidencefor inducing neuroplasticity following brain injury. Third, we describe and appraise the evidence basefor: (a) training-based interventions that induce neuroplasticity, (b) rehabilitation interventions not focusedon inducing neuroplasticity, (c) complementary and alternative interventions, (d) environmental enrichmentinterventions in the neonatal intensive care and community settings, and (e) parent–child interaction inter-ventions in the neonatal intensive care and community settings. Fourth, we explore emergent treatmentoptions at clinical trial, designed to induce brain repair following injury. In conclusion, early diagnosisenables early intervention, which improves child and parent outcomes. We now know which interventionsprovide the biggest gains and the information can be used to help inform parental decision making whendesigning treatment plans for their children

Handbook of Clinical Neurology,Vol. 162 (3rd series) Neonatal Neurology


Background : Cerebralpalsy (CP) is caused by a lesion in the developing infant brain. Recent neuroplasticity literature suggests that intensive, task-specific intervention ought to commenc eearly, during the critical period of neural development.

Aims : To determine whether “GAME” (Goals-Activity-MotorEnrichment), a motor learning, environmental enrichment intervention, is effective for improving motor skills in infants at high risk of CP.

Methods and procedures : Single blind randomised controlled trial of GAME versus standard care. Primary out come was motor skills on the Peabody Developmental Motor Scales - 2 (PDMS-2). Secondary out comes included Canadian Occupational Performance Measure (COPM) ,Bayley Scales of Infantand Toddler Development (BSID-III) and Gross Motor Function Measure - 66 (GMFM-66). Outcome assessors were masked to group allocation and data analyzed with multiple regression. Outcomes and results : All n=30 infants enrolled received the assigned intervention until 16 weeks postenrolment. At 12 months of age, n=26 completed assessments. Significant between group differences were found in raw scores on the PDMS-2 infavour of GAME (B=20.71,95%CI1.66-39.76,p=0.03) and at 12 months on the total motor quotient (B=8.29,95%CI0.13-16.45,p=0.05). Significant between group differences favored GAME participants at 12 months on the cognitive scale of the BSID-III and satisfaction scores on the COPM.

Conclusion : GAME intervention resulted inadvanced motor and cognitive outcomes when compared with standard care.

Research in Developmental Disabilities 55 (2016) 256–267

Colleen Peyton and Christa Einspieler

PEDIATRIC ANNALS • Vol. 47, No. 4, 2018


Infants who have graduated from a neonatal intensive care unit require close follow-up because they have a greater chance of experiencing later motor and cognitive difficulties; however, these difficulties are often challenging to identify at an early age. The General Movement Assessment is a low-cost and highly reliable tool that can indicate abnormal neurological development in young high-risk infants, but it has not yet been widely implemented in the United States. In this review, we discuss the literature about the use of the General Movement Assessment in high-risk infants and how to implement the tool in a
clinical setting.

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