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NumberResearch recommendationSee section
Physical therapy (physiotherapy and/or occupational therapy)4
1What are the greatest inhibitors of functional ability in children and young people with upper motor neurone lesions?4
2What is the optimal postural management programme using a standing frame in children aged 1–3 years?4
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?4
4What is the optimal duration for the passive stretch component of physical therapy?4
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?4
6What is the clinical and cost effectiveness and optimal age for modified constraint-induced movement therapy?4
Orthoses5
7What is the clinical and cost effectiveness of a prolonged stretch of the calf muscles with a hinged ankle-foot orthosis compared to an ankle-foot orthosis worn for a shorter time in children and young people with unilateral spasticity affecting the leg?5
8What is the clinical and cost effectiveness of wearing a hinged ankle-foot orthosis to prevent an equinus foot posture compared to an ankle-foot orthosis or solid ankle-foot orthosis?5
9What is the clinical and cost effectiveness of wearing an ankle-foot orthosis after surgery compared to not wearing an ankle-foot orthosis in children and young people with lower limb spasticity?5
10What is the clinical and cost effectiveness of dynamic thermoplastic orthoses compared to static orthoses in children and young people with unilateral spasticity affecting the arm who have abnormal posturing?5
11What is the clinical and cost effectiveness of a spinal orthosis compared to no orthosis when not in a supportive chair in children and young people with low tone and peripheral spasticity?5
Oral drugs6
12What is the clinical and cost effectiveness of night-time oral baclofen or oral diazepam combined with physical therapy compared to physical therapy only in children and young people who are at GMFCS level I, II, III, IV or V?6
13What is the clinical and cost effectiveness of night-time oral baclofen or oral diazepam combined with physical therapy and a night-time postural control system compared to physical therapy and a night-time postural control system only in children and young people who are at GMFCS level I, II, III, IV or V?6
14What is the comparative clinical and cost effectiveness of oral trihexyphenidyl, levodopa and baclofen in improving pain, positioning, and motor skills in children and young people with significant dystonia as a symptom of their non-progressive brain disorder?6
Botulinum toxin7
15What is the clinical and cost effectiveness of botulinum toxin type A when used routinely or according to clinical need in children and young people who are at GMFCS level I, II or III?7
16What is the clinical and cost effectiveness of treatment with botulinum toxin type A combined with a 6-week targeted strengthening programme compared to a 6-week targeted strength training programme only in school-aged children and young people with lower limb spasticity who are at GMFCS level I, II or III?7
17What is the clinical and cost effectiveness of botulinum toxin type A for reducing muscle pain?7
18What is the clinical and cost effectiveness of botulinum toxin type A compared to botulinum toxin type B for reducing spasticity while minimising side effects?7
Intrathecal baclofen8
19What is the predictive accuracy of intrathecal baclofen testing for identifying those children and young people who respond well to continuous pump-administered intrathecal baclofen treatment?8
20What is the clinical and cost effectiveness of continuous pump-administered intrathecal baclofen in terms of improving functional outcomes in children and young people who are at GMFCS level II?8
21What is the clinical and cost effectiveness of continuous pump-administered intrathecal baclofen compared to usual care in children and young people who are at GMFCS level IV or V?8
22What is the clinical and cost effectiveness of gait analysis as an assessment tool in studies to evaluate interventions such as continuous pump-administered intrathecal baclofen?8
Orthopaedic surgery9
23What is the clinical and cost effectiveness of soft tissue surgery in terms of preventing hip dislocation?9
24What is the clinical and cost effectiveness of single-event multilevel surgery in terms of producing benefits that continue after skeletal maturity has been achieved?9
Selective dorsal rhizotomy10
25Does selective dorsal rhizotomy followed by intensive rehabilitation performed between the ages of 3 and 9 years in children who are at GMFCS level II or III result in good community mobility as a young adult?10
26What is the clinical and cost effectiveness of selective dorsal rhizotomy compared to continuous pump-administered intrathecal baclofen in children and young people who are at GMFCS level IV or V?10

From: 1, Guideline summary

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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