Preventing deformities in paediatric cerebral palsy in poorly-resourced areas: A scoping review.
Shayne R van Aswegen, Mark Richards, Brenda Morrow
PMID 39507378WHAT IT FOUND
Weak, conflicting evidence exists for preventing hip displacement, contractures and scoliosis in severe cerebral palsy.
Supported standing, seating and sustained stretching showed some benefit in studies, but no tested home programmes for low-resource settings.
Key findings
01Postural management studies reported improved hip outcomes and fewer surgery or orthotic indications, but sleep-system evidence was weak and inconclusive.
02Stretching evidence was weak and conflicting, while sustained positional stretching with an orthotic or stander may increase lower limb range of motion and temporarily reduce spasticity.
03No study evaluated the effectiveness of home-based programmes for preventing musculoskeletal complications, although limited evidence suggested parent-delivered interventions may improve posture, positioning, self-care and reduce parental stress.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
This is a scoping review designed to describe the literature, not to prove that an intervention works. Most postural management and stretching evidence came from high-income countries, so it may not transfer to poorly-resourced settings. Many studies were small, non-randomised or of low quality, and overall support for 24-hour postural management was weak. No study evaluated the effectiveness of home-based programmes for preventing musculoskeletal complications in severe cerebral palsy. Initial screening, extraction and appraisal by a single researcher could have introduced bias. English-language limits may have excluded relevant studies from low- and middle-income countries.
Declared interests
The student researcher was supported by a research grant from the Department of Paediatrics and Child Health Research Committee at a university in the Western Cape. No further conflict-of-interest declaration is provided in the supplied text.
The easy way to misread this
Do not read this review as evidence that caregiver-delivered home programmes prevent hip displacement, contractures or scoliosis. No included study evaluated their effectiveness, and the available postural management and stretching evidence was weak or conflicting.