Efecto de la frecuencia e intensidad de intervenciones terapéuticas basadas en neurodesarrollo en niños con parálisis cerebral: una revisión sistemática / Effects of frequency and intensity of neurodevelopmentaltreatment interventions in children with cerebral palsy. a systematic review

Introduction: Cerebral palsy (CP) is a health condition causing very different levels of function limitation in children. Neurodevelopmental treatment is used with different frequencies and intensities, however there is no consensus regarding optimal dose. Objective: To perform a systematic assessment of the effectiveness of different intensities and/or frequencies of neurodevelopmental intervention in gross motor function, spasticity and range of joint motion, in children diagnosed with cerebral palsy. Materials and Methods: The systematic review was carried out following Cochrane Collaboration recommendations. Randomized and quasi-randomized clinical studies were considered, including > 14 year-old CP diagnosed children as subjects, classified using GMFCS I-V. The search was run in the following databases: PubMed, PEDro, CENTRAL, CINAHL Plus, EMBASE, OpenGrey, LILACS and SciELO. Two independent researchers were responsible for the selection of the studies. Disagreements were resolved by means of a consensus. A descriptive analysis was carried out on the selected studies. The Cochrane Collaboration’s tool for assessing risk of bias was used. Results: Only two of the 484 studies met all eligibility criteria. None of the selected studies showed significant differences between the high intensity or high frequency groups compared to the control groups. Conclusions: There is not enough evidence to conclude if a type of therapeutic frequency or intensity will determine the therapeutic results of neurodevelopmental treatment that are expected in children with CP.

Introducción: La parálisis cerebral es una condición de salud que determina grados muy variables de limitación en la función de niños y niñas. El neurodesarrollo, como intervención terapéutica, se utiliza con variadas frecuencias e intensidades no existiendo consenso respecto de la mejor dosificación. Objetivo: Evaluar sistemáticamente la efectividad de distintas intensidades y/o frecuencias de la intervención de neurodesarrollo en niños diagnosticados con parálisis cerebral en la función motora gruesa, espasticidad y rango articular. Material y Método: La revisión sistemática se realizó siguiendo las recomendaciones de la Colaboración Cochrane. Se incluyeron ensayos clínicos aleatorizados o cuasi aleatorizados, que contuvieran como población niños con PC menores de 14 años, clasificados según GMFCS I-V. La búsqueda se llevó a cabo en las bases de datos PubMed, PEDro, CENTRAL, CINAHL Plus, EMBASE, OpenGrey, LILACS y SciELO. La selección de los estudios la realizaron dos investigadores independientes. Los desacuerdos se resolvieron mediante consenso. Se realizó un análisis descriptivo de los estudios seleccionados. La evaluación del riesgo de sesgo se realizó con la herramienta de Colaboración Cochrane. Resultados: De los 484 trabajos, sólo dos reunían todos los criterios de elegibilidad. Ninguno de los trabajos seleccionados demostró diferencias significativas entre los grupos de alta intensidad o frecuencia en comparación con el control. Conclusiones: No existe evidencia suficiente para concluir si un tipo de frecuencia o intensidad de intervención terapéutica basada en neurodesarrollo determinará los resultados clínicos esperados en niños con parálisis cerebral.

Survey on Clinical Application of 'Neurodevelopmental Treatment'

OBJECTIVE: To investigate the recognition about clinical application of "neurodevelopmental treatment (NDT)". METHOD: We surveyed on the recognition for Bobath and NDT concepts and its training programs provided by Korean Academy of Rehabilitation Medicine from Jan 2009 to Feb 2009. The survey was made for physiatrists and physical therapists (PTs), separately. One hundred twelve physiatrists and 322 PTs have participated. RESULTS: In physiatrist, interest in NDT was very high (98%), and the need for further knowledge of NDT was also high (95%). Though the NDT was mainly used techniques in neuro-rehabilitation setting, the expectation about effectiveness of it was moderate (56%) and the requirement of changing concepts of the NDT was very high (93%). PTs have carried out NDT most frequently with Bobath's concepts, but they also did not regard NDT as the best procedure. PTs emphasized the importance of their handling technique in NDT practices and also had high interest in the other maneuvers beside Bobath's. CONCLUSION: Physiatrists and PTs regard NDT as one of the most important treating method for patients with brain lesions, but it is not approved as the most effective method yet. Nowadays NDT is changing or adapting, with discarding some of the old Bobath's concepts and adding new modern scientific knowledge. Therefore we suggest that physiatrists to give PTs the revised NDT concepts and evidence based the other therapeutic methods. And the NDT needs to be verified its therapeutic efficacy with evidence based view points through proper studies.

Survey of the Demands of the Parents of Children with Cerebral Palsy

OBJECTIVE: Because the treatment of children with cerebral palsy needs much time and efforts, the parents are suffering from longstanding treatment and financial problems. Home therapy based on the neurodevelopmental treatment strategy might help to solve these problems extending the time of treatment and helping carry over the effects of the treatment. The purpose of this study is to evaluate current difficulties in managing the children with cerebral palsy and needs of the parents, so that we can obtain a basic information to make the educational program for home therapy. METHOD: A cross-sectional study was performed by questionnaire from the parents of cerebral palsy. RESULTS: The parents recognized the importance of home therapy and were enthusiastic to manage their children at home in 72.7%. However, 38.2% of the parents were lack of practical idea about the skill and knowledge of home therapy, and 51.7% had much burden about time and the expenses of the treatment. CONCLUSION: The needs of home therapy for cerebral palsy by parents were high enough to develop the home program. Thus, practical program of home therapy with education of the parents can improve motor development of the children with cerebral palsy and reduce the time and expenses.