Intensive physiotherapy with subsequent community-based rehabilitation: two cases of cerebral malaria in rural areas of Malawi.

The paper reports only 2 cases, so it cannot show whether the treatment works for children with cerebral malaria. There was no control group, randomisation, or blinding, and the paper does not compare the children with similar children who did not receive this treatment. The children received intensive physiotherapy, educational guidance, mother-centred treatment, and community-based rehabilitation from mothers and volunteers together, so the contribution of any single component cannot be separated. Case 1 had no improvement before and after intensive physiotherapy, and walking, running and jumping did not improve during intensive physiotherapy in either case. The authors say the later improvement may be related to rural roads, long distances, and children being carried by mothers, so the results may not apply to other environments. The paper uses GMFM-88 motor scores as the outcome, and does not report speech, cognition, epilepsy, or ADL outcomes after treatment.

The authors declared no apparent conflicts of interest. The paper states that the Sue Ryder Foundation in Malawi provided community-based rehabilitation and volunteers at each clinic helped with rehabilitation.

Do not conclude that 2 weeks of intensive physiotherapy caused the later GMFM-88 gains. The paper has only 2 cases, case 1 showed no immediate improvement, and the children also received educational guidance and continued rehabilitation from mothers and community volunteers, so the contribution of any single component cannot be separated.