Table 6: Why Treatment Plans Can Fail.

Treatment plans, even when well-planned and well-coordinated, may fail to achieve expected results. Potential pitfalls are outlined here.

Reason	Comments/Examples
Incorrect/Incomplete diagnosis	Neuromuscular and neurometabolic disorders may initially appear similar to individuals with CP and only later demonstrate clear progressive decline. Within a diagnosis of CP, dystonia can easily be overshadowed by spasticity, which can lead to suboptimal medical management100.
Insufficient treatment	There may be limitations from an insurance or psychosocial perspective
Inappropriate treatment	Children with dystonia are not good candidates for SDR77.
Limited effective treatment options	Hyperkinetic movements are notoriously difficult to treat.
Overlooked comorbidity: pain, anxiety or mood	Patient/family motivation is critical for the therapies that are required to complement and make medical or surgical interventions successful
Patient expectations differ from provider goals	Benefit from intervention is typically limited. Realistic, concrete goals should be set jointly between providers and families, communicated clearly, and re-evaluated regularly.
Side-effects > benefits	Some surgical interventions, both orthopedic and neurosurgical, can produce unwanted reduction in motor strength. Paradoxically, spasticity can be useful in some situations for scaffolding postures100.