We will use explicit criteria for rating the overall strength of the evidence for each key intervention-outcome pair for which the overall risk of bias is not overwhelmingly high. 724-487-0519. Key: [mh] medical subject heading; [sh] subheading; [tiab] keyword in title or abstract; [la] language; [pt] publication type; jsubsetk consumer health subset; [dp] publication date. Hi this is an amazing site! The adult with cerebral palsy. PMID: 8969730. Research in this area is directed at adapting biomedical technology to help people with cerebral palsy cope with the activities of daily living and achieve maximum function and independence. Murphy CC, Yeargin-Allsopp M, Decoufle P, et al. Call 724-487-0519 to speak with a member of our team. Shea BJ, Grimshaw JM, Wells GA, et al. Nursing goals for a client with cerebral palsy include optimize mobility and prevent deformity, improve nutritional status, strengthen family support, foster self-care, enhanced communication and provide quality of life. Is the effectiveness of behavioral interventions modified by age, race, severity, functional status (e.g., GMFCS level), or initial nutritional status? For randomized trials, we will use the Cochrane risk of bias tool. Nursing Care Plans. Economic costs associated with mental retardation, cerebral palsy, hearing loss, and vision impairment--United States, 2003. Additionally, the need for management into later life has increased, and the optimal interventions for adults with feeding difficulties are unknown.16,32. The TOO and the EPC work to balance, manage, or mitigate any potential conflicts of interest identified. Did researchers rule out any impact from a concurrent intervention or an unintended exposure that might bias results? Disabil Health J 2009;2:45-8. We will assess the quality of studies using the following established tools (Appendix B) for various study types: Two senior investigators will independently assess each included study, with disagreements between assessors resolved through discussion to reach consensus. These are broad generalizations that lack a specific set of criteria. Feeding difficulties related to CP can affect an individual’s nutritional and growth status and quality of life, as well as contribute to comorbidities including respiratory conditions and gastrointestinal symptoms. PMID: 16467053. The impact of antireflux procedures in addition to gastrostomy is also unknown. Prevalence of cerebral palsy: Autism and Developmental Disabilities Monitoring Network, three sites, United States, 2004. For each KQ, the relevant population, interventions, comparators, outcomes, timing, and setting are as follows: Individuals with CP and feeding difficulties (all ages and severities), Positioning, oral appliances, oral stimulation, sensorimotor facilitation, and caregiver training, All settings will be considered (e.g., home, clinic, hospital, institutional settings), Food thickeners, caloric supplementation with formulas, vitamin supplementation, and altering food consistency (e.g., pureeing), All settings will be considered (e.g., home, clinic, hospital, and institutional settings), Individuals with CP and feeding difficulties but without reflux (all ages and severities), Tube feeding via g-tube or j-tube with or without fundoplication, Nonsurgical feeding interventions (behavioral and nutritional) or oral feeding (no intervention), Individuals with CP and feeding difficulties with significant reflux (all ages and severities), Individuals with CP and feeding difficulties who initially present without reflux but develop reflux following g-tube placement (all ages and severities), J-tube or fundoplication; compared with the other intervention. ... To learn more about these teams, visit Care Team For Managing Cerebral Palsy. Another comment noted the importance of considering the quality of nutritional substances in addition to the quantity. Provide audio and visual activities for the child who is quadriplegic. Growth status as proxies for nutrition (height including leg length or tibia length, weight, skinfold status, and energy expenditure), Nutritional status (measures of energy balance and micronutrient scores), Improved swallowing (including feeding efficiency score), Need for surgical or nutritional intervention, Days of antibiotics for aspiration needed, Validated measures of quality of life (e.g., SF-36, CAPE, HRQOL), Patient and family satisfaction and stress, Decreased parent/caregiver time spent on feeding-related activities, Physical and mental health of primary caregiver, Reflux outcomes (episodes of reflux and duration). Long-term survival for a cohort of adults with cerebral palsy. Your email address will not be published. Did the study account for secular trends and regression to the mean? Are the potential outcomes, including harms, pre-specified by the researchers? Disabil Rehabil 2007 Mar 30;29(6):453-63. 10(12)-EHC063-EF. They are selected to provide broad expertise and perspectives specific to the topic under development. We will summarize results of those reviews assessed as higher quality in the current CER and augment the summary with results of studies meeting our inclusion criteria and not addressed in prior reviews. Cerebral palsy (CP) is a common group of neurological developmental disorders that affect a person’s ability to move as well as muscle tone and posture. We will assess the applicability of findings reported in the included literature to the general population of individuals with CP and feeding difficulties by determining the population, intervention, comparator, and setting in each study and developing an overview of these elements for each intervention category. Cerebral palsy (CP) is “a group of permanent disorders of the development of movement and posture, causing activity limitations, attributed to nonprogressive disturbances that occurred in the developing fetal or infant brain. Peer reviewers do not participate in writing or editing of the final report or other products. Further, in the opinion of our TEP, most studies of relevance in the area are published in English. KQ3d. Multiple approaches may be used in children with growth failure, including sensorimotor stimulation, positioning, food thickeners, and caloric supplementation. What is the comparative effectiveness of tube feeding when compared with oral feeding or with nutritional and behavioral interventions in individuals with CP who present with feeding difficulties, including malnourishment, failure to thrive, aspiration, and excessive caregiver burden? Because of their role as end-users, individuals are invited to serve as Key Informants and those who present with potential conflicts may be retained. Are the inclusion/exclusion criteria measured using valid and reliable measures, implemented consistently across all study participants? Described all measures used, if any, to blind outcome assessors from knowledge of which intervention a participant received. Guidelines have been published by the American Academy of Neurology on the use of pharmacologic agents to treat spasticity in children and adolescents with CP.30 However, there is a limited evidence base for the majority of CP interventions, including those that address nutrition and growth.31 Despite a range of potential feeding interventions for patients with CP, synthesis is lacking on the efficacy, safety, and applicability of these interventions. Neurology 2010 Jan 26;74(4):336-43. MMWR Morb Mortal Wkly Rep 1995 Sep 22;44(37):694-9. Are interventions/exposures assessed using valid and reliable measures, implemented consistently across all study participants? Arneson CL, Durkin MS, Benedict RE, et al. At Cardinal LifeCare, our legal nurse consultants create objective and evidence-based life care plans for patients with cerebral palsy, detailing their future healthcare needs and medical cost projections. PMID: 17370477. BMC Med Res Methodol 2007 Feb 15;7:10. We believe that by working together, families and researchers can make a difference in the lives of people affected by cerebral palsy. Peer reviewers are invited to provide written comments on the draft report based on their clinical, content, or methodological expertise. Although cerebral palsy is a lifelong disability, there are many interventions that can help reduce its impact on the body and the individual’s quality of life. AHRQ Publication No. PMID: 15466117. PMID: 11225958. Cerebral palsy is one of the most complex of the common permanent disabling conditions. Rockville, MD. Considerable uncertainty remains regarding the appropriate interventions, especially in older individuals. AHRQ Publication No. March 2013. Bias is assessed as a judgment (high, low, or unclear) for individual elements from five domains of bias (selection, performance, attrition, reporting, and other). To get started, call us today at 724-487-0519. Admissible evidence (study design and other criteria). Dysphagia in children with severe generalized cerebral palsy and intellectual disability. Comparative Effectiveness Review No. Rockville, MD: Agency for Healthcare Research and Quality. Technical Experts must disclose any financial conflicts of interest greater than $10,000 and any other relevant business or professional conflicts of interest. Cochrane Collaboration modified tool for assessing risk of bias for RCT's, PART IIUse this form to assess risk of bias for randomized controlled trials. We will limit retrieval to English-language studies only as we identified a high number of international studies in our initial scan of the literature and feel that globally relevant studies are likely being identified. Providing a primary care medical home for children and youth with cerebral palsy. Were the important confounding and modifying variables taken into account in the design and analysis? Crichton JU, Mackinnon M, White CP. The growing want for safety and forestall harm 1) keep away from youngsters from dangerous objects, for instance might be dropped. There is no known cure for this condition, but treatment is geared toward supportive therapy and management of symptoms. Diversional Activity Deficit (Child) related to poor social skills The child will engage in adequate diversional activity to maximize growth and development. Technical Experts do not do analysis of any kind nor contribute to the writing of the report and have not reviewed the report, except as given the opportunity to do so through the public review mechanism.