Article

OBJECTIVES: To conduct a systematic review of the evidence for the
management of tone in infants 0-24 months of age,
with or at risk of developing
cerebral palsy. METHOD: This review was conducted and reported following the
Preferred Reporting Items for Systematic Reviews and Meta-analyses Statement. The
Cochrane Central Register of Controlled Trials, Embase, MEDLINE, CINAHL Plus and
PsycINFO databases were systematically searched for relevant articles. Inclusion
criteria were: children aged 0-24 months, identified as at risk of, or having
cerebral palsy; >/=25% of participants </=24 months, and included a standardized
assessment of tone. Only peer reviewed journal articles were considered. Eligible
studies were coded using the Oxford Levels of Evidence. Methodological quality
was assessed using the PEDro scale for randomized controlled trials and the
checklist for assessing the quality of quantitative studies of Kmet, Cook and Lee
for non-randomized control trials. RESULTS: A total of 4838 studies were
identified. After removing duplicates and unrelated studies, a total of 56 full
text studies were reviewed. A total of five studies met inclusion criteria, two
of which were RCTs, two pre-/post-test designs and one retrospective case audit.
Interventions included BoNT-A, Oral Baclofen, Neurofacilitation of Developmental
Reaction and Neurodevelopmental Therapy. The quality of evidence ranged from
limited to moderate. CONCLUSION: The management of tone in infants and young
children is not well described, with a dearth of high-level evidence to support
intervention in the 0-24 month age-range. This is in contrast to a recent review
completed by Novak et al. (2013) who report high levels of evidence of
interventions for children with cerebral palsy, over 2 years of age. Implications
for Rehabilitation High level of evidence to support clinical decision making for
the management of tone in young children 0-24 months is not available. The lack
of available evidence in the management of tone of young children underpins
service delivery and intervention and impacts on patient outcomes. In the absence
of clear research evidence, the systematic application of sensitive outcome
measures is required to confirm treatment effects and generate new evidence.
Hypertonia should not be managed in isolation. Consideration needs to be given to
all components of the ICF-CY.

Langue : ANGLAIS