Table 4: Selected non-pharmacologic therapies used for symptomatic treatment of cerebral palsy.
Four commonly-used treatments are outlined here with summaries of evidence for specific indications as well as typical contraindications. Evidence is derived from a systematic review36 and, as in that reference, uses the evidence alert traffic light system.
| Treatment |
Major effects and level of evidence
(Evidence alert traffic light system: Green light: “Effective, therefore do it”; Yellow light: “Measure: Uncertain effect”; Red light: “Ineffective; therefore don’t do it”)36 |
Contraindications for use |
| Non-invasive treatments | ||
| Serial casting |
Improves range of motion at the ankles. Effects may be short-lived but may be functionally helpful in selected partially-ambulatory individuals.
Other indications (e.g. use at knees) lack adequate evidence. Not physiologically plausible as a means of directly impacting spasticity |
heterotopic ossification, bone fracture/dislocation, occlusive venous/arterial disease75 |
| Orthotics (e.g. ankle-foot orthotics, or AFOs) | Low-to-very low quality of evidence for/against benefit on gait parameters, limb function, or prevention of contracture. | insufficient voluntary dorsiflexion control, fixed equinus deformity, insufficient heel strike, hypertonic reflex foot activity, lack of ambulation76 |
| Surgical treatments | ||
| Selective Dorsal Rhizotomy (SDR) |
Effective for reducing spasticity and improving gait kinematics
Evidence for improved gross motor functioning but no evidence regarding translation to improved participation in activities |
dystonia, ataxia, fixed contractures 77 |
| Single-event multilevel surgery with associated therapy | Low-quality supporting evidence of improved long-term functional mobility | severe weakness, uncontrolled spasticity or dystonia, progressive neurologic disorder, inability to perform postoperative rehabilitation78 |