NumberResearch recommendation
1What are the greatest inhibitors of functional ability in children and young people with upper motor neurone lesions?

Why this is important
Children and young people with upper motor neurone lesions may experience: The relationships between these factors, and the extent to which the child or young person can develop or maintain functional ability, remain unclear. Prospective cohort studies, or large cross-sectional studies, are needed to explore the relationships between positive and negative effects of upper motor neurone lesions and to determine which factor is the greatest inhibitor of functional ability. The studies should incorporate classification of functional ability based on validated scales, such as the GMFCS.
2What is the optimal postural management programme using a standing frame in children aged 1–3 years?

Why this is important
Children who are at GMFCS level IV or V may benefit from using a standing frame as part of a postural management programme. Clinical benefits might include improved weight bearing and walking and, as a result, reduced hip migration. Postural management programmes involving the use of standing frames are part of established clinical practice. However, the individual elements that optimise the effectiveness of such programmes merit further research. The research should compare the effectiveness of postural management programmes that incorporate different durations and timings of standing frame use. For example, what is the effectiveness of 1 hour per day in a single session compared with two sessions of 30 minutes per day? The research should be conducted in children and aged 1–3 years. These children are likely to benefit the most from using standing frames (in terms of developing well-formed femoral heads and acetabulums) and they should find the use of standing frames acceptable (because they are lighter than older children and they do not have severe contractures).
3What is the clinical and cost effectiveness of 24-hour postural management programmes in non-ambulatory children and young people with bilateral spasticity affecting all four limbs?
4What is the optimal duration for the passive stretch component of physical therapy?
5What is the clinical and cost effectiveness of activity-based context-focused physical therapy compared with child-focused physical therapy in children and young people who are at GMFCS level I, II or III?
6What is the clinical and cost effectiveness and optimal age for modified constraint-induced movement therapy?

From: 4, Physical therapy (physiotherapy and/or occupational therapy)

Cover of Spasticity in Children and Young People with Non-Progressive Brain Disorders
Spasticity in Children and Young People with Non-Progressive Brain Disorders: Management of Spasticity and Co-Existing Motor Disorders and Their Early Musculoskeletal Complications.
NICE Clinical Guidelines, No. 145.
National Collaborating Centre for Women's and Children's Health (UK).
London: RCOG Press; 2012 Jul.
Copyright © 2012, National Collaborating Centre for Women's and Children's Health.

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