The essential elements of a home-based program to limit musculoskeletal complications in children with severe cerebral palsy living in resource-limited settings - a Scoping review

This review investigates the use of home-based physical interventions to mitigate musculoskeletal (MSK) complications in children with severe CP in resource-limited settings (RLS).

The aim is to summarise the evidence for programs and interventions that mitigate MSK complications in children with severe CP and make recommendations for a home-based program for RLS.

Method

Scientific databases and professional health and association websites were searched for studies and reports describing guidelines, interventions or programs for children aged 0 – 18 years with severe or non-ambulant CP (GMFCS level III-V), that included aims for the prevention of MSK complications. Articles reporting advanced technology devices, and surgical and pharmacological interventions were excluded.

Results

Fifty-seven studies or reports were included in the review. Low grade evidence exists for 24-hour postural management, supported standing, sustained stretching, and splinting to mitigate MSK complications in children with CP. Caregiver training and support, and integration of the program into daily routines were identified as important components for successful implementation.

Conclusion

Clinical guidelines and evidence that support caregiver-delivered interventions to reduce MSK complications in children with severe CP are limited, and only weak recommendations can be made.

Clinical implications: There is a need for context-specific, home-based intervention programs to prevent MSK complications in children with CP in RLS.