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Feeding by tube into the stomach or intestine versus feeding by mouth for children with cerebral palsy

Children with cerebral palsy can have problems with sucking, chewing and swallowing. This can make it difficult to eat and lead eventually to undernutrition or problems caused by food going down the wrong way and getting into the lungs. Mealtimes may be long and distressing for the child and for their carer. Increasingly, feeding by a surgically‐inserted tube into the stomach (gastrostomy) or via a tube inserted into the middle of the small intestine (jejunostomy) is used to provide such children with nutrition. These processes can be costly, as well as being emotionally difficult for families, and complications are possible. We searched 12 databases in July 2012 but did not find any studies that randomly put children into two groups to investigate the effects of tube feeding via gastrostomy (or jejunostomy) compared to feeding by mouth only. Well‐designed studies are needed to help medical professionals and families make difficult decisions about how to treat children with cerebral palsy and physical difficulties in eating.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Constraint‐induced movement therapy in the treatment of the upper limb in children with hemiplegic cerebral palsy

This therapy involves constraining the non‐affected arm to encourage performance of therapeutic tasks with the affected arm, which children normally tend to disregard. Two clinical trials showed positive trends in support of constraint‐induced movement therapy (CIMT) and Forced Use, whilst another demonstrated a positive treatment effect favouring modified CIMT as a treatment for children with hemiplegic cerebral palsy. This evidence is based on one small randomised controlled trial with methodological limitations, one trial with ambiguous methodology and reporting and one controlled clinical trial. There is a need for additional high quality research to adequately support the use of this therapy.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Speech and language therapy for children with cerebral palsy might improve their communication skills, but more research is needed.

Cerebral palsy (CP) is a movement disorder caused by damage to the brain before, during or soon after birth. The ability for people with CP to communicate effectively is often impaired by problems with speech and also gestures usually used in communication. Speech and language therapy aims to help people with CP maximise their communication skills. This can include ways of enhancing natural forms of communication, introducing aids such as symbol charts or devices with synthetic speech, and training communication partners. The review found some weak evidence that speech and language therapy might help children with CP, but more research is needed.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

There is high level evidence to support the safety and effectiveness of Botulinum toxin ‐A (BoNT‐A) as an adjunct to managing the upper limb in children with cerebral palsy.

When injected into muscles BoNT‐A reduces muscle tightness. When used in conjunction with occupational therapy, the aim of BoNT‐A injections in the arms and hands is to improve movement and function in treated limbs. This review demonstrated improvements on a range of measures with the combined treatment. In the absence of significant side effects, injection of BoNT‐A has been identified as a safe and effective treatment for upper limb spasticity when used in combination with occupational therapy in children with cerebral palsy.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

Botulinum toxin type A injections for the treatment of lower limb spasm in cerebral palsy

Cerebral palsy (CP) is a non‐progressive lifelong condition resulting from damage to the newborn brain. Most infants have spasms (spasticity) affecting at least one leg that prevents normal movement. It can cause muscle contractures and deformities and the affected muscles do not grow as rapidly as neighbouring bone and soft tissue. Treatment includes physiotherapy, oral anti‐spasticity drugs, casts, splints and orthopaedic surgery. Injection of botulinum toxin (BtA) into muscle causes local muscle weakness and so may help counter spasticity. This review found that published, controlled evidence was weak as they identified three controlled trials involving only a small number of children (2 to 11 years). Children receiving a single course of injections of BtA (Botox®, 3 to 8 µg/kg or Dysport®, 15 µg /kg) into the calf muscle tended to have an improved pattern of walking (gait) compared with inactive injections (placebo). Both BtA injections and lightweight walking plaster casts below the knee (for four to six weeks) produced similar significant improvements in gait. Some calf pain was reported among the 26 children injected with BtA and parents reported inconvenience with wearing casts and weakness of legs following removal.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Interventions for drooling in children with cerebral palsy

Many children with CP have difficulty controlling saliva. Drooling varies in severity and can be distressing for the children, families and caregivers. Excessive drooling can cause constant damp soiled clothing, unpleasant odour, irritated, chapped or sore skin around the mouth and chin, skin and mouth infections, dehydration, difficulties chewing, interference with speech, damage to books, communication aids, computer and audio equipment. There is also risk of social rejection and social isolation for these children.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Thumb‐in‐palm surgery appears to lead to modest improvement in hand function and quality of life in people with cerebral palsy.

Cerebral palsy (CP) is a movement disorder caused by damage to the brain around birth. It causes muscle spasms and contractions that can lead to a condition called thumb‐in‐ palm deformity, severely limiting hand function. Thumb‐in‐palm surgery is sometimes tried to improve ability to use the thumb. This review found no randomized controlled trials of thumb‐in‐palm surgery, but some other types of studies. Although some people with CP who had thumb‐in‐palm surgery experienced some improvement in movement, the improvement was generally modest. Trials are needed to show if thumb‐in‐palm surgery can improve function and quality of life for people with CP.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Magnesium sulphate for women at risk of preterm birth for neuroprotection of the fetus

Magnesium sulphate given to women at risk of preterm birth helps to protect the baby's brain and improve long‐term outcomes.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Early (up to seven days) postnatal corticosteroids for preventing chronic lung disease in preterm infants

Corticosteroids can reduce lung inflammation in newborns with chronic lung disease, but there are major adverse effects of the drugs. Chronic lung disease is a major problem for newborn babies in neonatal intensive care units. Persistent inflammation of the lungs is the most likely cause. Corticosteroid drugs have been used to either prevent or treat chronic lung disease because of their strong anti‐inflammatory effects. This review of trials found that the benefits of giving corticosteroids to infants up to seven days of age may not outweigh the known adverse effects. The beneficial effects were a shorter time on the ventilator and less chronic lung disease, but the adverse effects included high blood pressure, bleeding from the stomach or bowel, perforation of the bowel, an excess of glucose in the bloodstream and an increased risk of cerebral palsy at follow‐up. Use of early corticosteroids, especially dexamethasone, to treat or prevent chronic lung disease should be curtailed until more research has been performed.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Treadmill interventions with partial body weight support in children under six years of age at risk of neuromotor delay

Children who have a diagnosis of Down syndrome or cerebral palsy, or who are born pre‐term, may be delayed in their motor development. Delays in motor development limit children's ability to move and achieve motor milestones such as walking, running and jumping. Helping children to walk is often the focus of therapeutic intervention. There is a body of literature to suggest that the best way to do this is by getting the child to practice stepping with appropriate support. Treadmill training, in which the child is supported by a harness, provides an opportunity for children to walk with support for long enough periods of time to acquire the necessary motor abilities for independent walking.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Magnesium sulphate for women at term for neuroprotection of the term fetus

Babies born to mothers who experience complications during pregnancy such as preterm birth (early birth before 37 weeks of pregnancy) and intrauterine infection (infections in the uterus) have a higher risk of a movement disorder called cerebral palsy. Cerebral palsy is a broad term used to describe a non‐progressive physical disorder of movement or posture that is acquired in early life, and that results from complications in brain development. It may also be associated with intellectual disabilities, behavioural disorders, sensory defects (blindness and deafness) and seizures.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Creatine for women in pregnancy for neuroprotection of the fetus

This review did not find any randomised controlled trials that looked at whether creatine, given to a mother in pregnancy, can help protect her baby's brain.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Repeated lumbar or ventricular punctures in newborns with intraventricular hemorrhage

Intraventricular hemorrhage (IVH) is a major complication of premature birth and a cause of cerebral palsy and hydrocephalus. Repeated early lumbar puncture or ventricular taps have been advocated as a way of avoiding hydrocephalus and protecting the brain from pressure. It was thought that the risk of hydrocephalus and the need for a ventriculoperitoneal shunt might be reduced by the removal of protein and old blood in the cerebrospinal fluid. This hypothesis has been tested in four randomised trials involving premature infants in whom IVH (with or without established enlargement) was diagnosed by ultrasound. There is no evidence that early tapping of cerebrospinal fluid by lumbar puncture or ventricular tap reduces the risk of shunt dependence, disability, multiple disability or death. The use of repeated taps was associated with an increased risk of central nervous system infection. Thus the early use of early tapping cannot be recommended. Removing cerebrospinal fluid should be reserved for cases where there is symptomatic raised intracranial pressure.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Comparing continuous electronic fetal monitoring in labour (cardiotocography, CTG) with intermittent listening (intermittent auscultation, IA)

Monitoring the baby's heartbeat is one way of checking babies' well‐being in labour. By listening to, or recording the baby's heartbeat, it is hoped to identify babies who are becoming short of oxygen (hypoxic) and who may benefit from caesarean section or instrumental vaginal birth. A baby's heartbeat can be monitored intermittently by using a fetal Pinard stethoscope (special trumpet shaped device), or by a hand‐held Doppler device. The heartbeat can also be checked continuously by using a CTG machine. This continuous CTG method is also called electronic fetal monitoring (EFM). It produces a paper recording of the baby's heart rate and mother's labour contractions. Whilst a continuous CTG gives a written record, it prevents women from moving during labour. This means that women may be unable to change positions freely or use a bath to help with comfort and control during labour. It also means that some resources tend to be focused on the needs to constantly interpret the CTG and not on the needs of a woman in labour.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Prophylactic phototherapy for preventing jaundice in preterm very low birth weight infants

Preterm (< 37 weeks gestational age) or low birth weight (LBW; birth weight < 2500 g) infants have a greater risk of developing jaundice compared to term or normal birth weight infant. This can be concerning because jaundice (caused by high levels of serum unconjugated bilirubin) could lead to permanent brain damage and/or death.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Speech therapy for children with early acquired dysarthria

Dysarthria is a disorder which reduces the control of movements for speech. Children with dysarthria often have shallow, irregular breathing and speak on small, residual pockets of air. They have low pitched, harsh voices, nasalised speech and very poor articulation. Together, these difficulties make the children's speech difficult to understand. Dysarthria is caused by neurological impairment and can arise early in children's lives, from neurological damage sustained before, during or after birth, such as in cerebral palsy, or in early childhood through traumatic brain injury or neurological disease. Communication difficulties have a profound impact on children’s development. They reduce the quality of life of children with cerebral palsy and place children at risk of social exclusion, educational failure and later unemployment. Speech and language therapy aims to help children to control the movements for breathing and speech and so become more intelligible. Small, observational studies have suggested that for some children therapy might have been associated with positive changes in intelligibility and clarity of children's voices. This review aimed to investigate if therapy is generally effective for children with dysarthria acquired early in life, and if certain types of therapy may be better than others. We found no randomised controlled trials or controlled group studies which investigate the effects of speech and language therapy to improve the speech of children with dysarthria acquired below three years of age. Rigorous research, using randomised controlled trials, is needed to evaluate if therapy can help children to increase the intelligibility of their speech and if enhanced intelligibility increases children's participation in social and educational activities and their quality of life.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

Interventions for swallowing difficulty in children with neurological impairment

Oropharyngeal dysphagia, or swallowing difficulty, can be defined as problems with chewing and preparing food, difficulty moving food through the mouth to the back of the tongue, and difficulty with swallowing and movement of food through the 'throat' or pharynx. Many children with neurological impairment experience swallowing difficulties, including those with acquired brain impairment (for example, cerebral palsy, traumatic brain injury, stroke), genetic syndromes (for example, Down syndrome, Rett syndrome) and degenerative conditions (for example, myotonic dystrophy).

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Thyroid hormones for preventing neurodevelopmental impairment in preterm infants

No evidence from trials that thyroid hormone therapy is effective in preventing problems such as respiratory distress syndrome in preterm babies. Thyroid hormones are needed for the normal growth and maturity of the central nervous system, as well as the heart and lungs. Children born without sufficient thyroid hormones can develop serious mental retardation. It is believed that low levels of thyroid hormones in the first few weeks of life (transient hypothyroxinemia) in preterm babies born before 34 weeks may cause this abnormal development. The review of trials found no evidence that using thyroid hormones in preterm babies is effective in reducing the risk of problems caused by insufficient thyroid hormones.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Vitamin K prior to preterm birth for preventing neonatal periventricular haemorrhage

Vitamin K given to women before a very preterm birth does not decrease the risk of bleeding in the brain and associated neurological injury in babies born very preterm.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Immediate or deferred delivery of the preterm baby with suspected fetal compromise for improving outcomes

When there is concern that a baby in the womb may not be receiving enough oxygen or nutrients, the choice is to deliver the baby immediately following a course of steroids to help the baby’s lungs to mature or to wait as long as is thought to be safe. Waiting allows the baby to develop as much as possible and decreases the risks associated with prematurity. Immaturity of the newborn can lead to respiratory distress, hypothermia (reduced body temperature), low blood sugar levels, infection and jaundice. Remaining in the womb may mean the baby experiences damage of vital organs from the lack of oxygen. The aim of this review was to assess which management option was better for mothers and babies.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Medical Encyclopedia

  • Cerebral palsy
    Cerebral palsy is a group of disorders that can involve brain and nervous system functions, such as movement, learning, hearing, seeing, and thinking.
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Systematic Reviews in PubMed

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