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Bobath Approach For Cerebral Palsy Pdf UPDATED Download



The positive effects of Bobath therapy on spasticity are known, but studies using objective data tools that can evaluate these positive effects are limited. The purpose of this study is to examine the changes in lower extremity muscle tone and viscoelastic properties of children with spastic cerebral palsy who received Bobath therapy. Thirty-three children with CP, aged between 5 and 15 (18 girls, 15 boys) were included in the study. Initial evaluations according to the evaluation parameters were performed with the Modified Ashworth Scale and MyotonPRO Digital Palpation Device, and after the initial evaluation, all children continued the neurodevelopmental therapy (NGT) that they had received twice a week for 6 weeks. Muscle tone was measured with MAS, and muscle tone, stiffness, and flexibility levels were measured with MyotonPRO Digital Palpation Device. According to the results of this study, it has been determined that the sensitivity of the MiyotonPRO digital palpation device is higher and more reliable than MAS in evaluating spasticity in patients with cerebral palsy. Therefore, it is recommended to use MiyotonPRO digital palpation device, which is more objective and reliable in evaluating spasticity in children with cerebral palsy in future studies.




Bobath Approach For Cerebral Palsy Pdf Download


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A total of 105 patients with spastic cerebral palsy were enrolled and randomly assigned to three groups: the BMMSC group, the BMMNC group and the control group. Patients in both transplantation groups received four intrathecal cell injections. Patients in the control group received Bobath therapy. The gross motor function measure (GMFM) and the fine motor function measure (FMFM) were used to evaluate the therapeutic efficacy before transplantation and 3, 6, and 12 months after transplantation.


BMMSC transplantation for the treatment of cerebral palsy is safe and feasible, and can improve gross motor and fine motor function significantly. In addition, compared with BMMNC, the motor function of children improved significantly in terms of gross motor and fine motor functions.


Cerebral palsy is the most common physical disability of childhood. In the last decade, major discoveries have been made in early diagnosis, prevention, and treatment, altering incidence, prognosis, and treatment responsivity. In high-income countries such as Australia, motor severity has lessened and the incidence of cerebral palsy has fallen by a staggering 30% [1]. Non-ambulant forms of cerebral palsy, co-occurring epilepsy, and co-occurring intellectual disability are less frequent, meaning more children than ever before can walk [2]. Epidemiologists propose that the reduction in incidence and severity is likely due to a combination of comprehensive obstetric and neonatal intensive care interventions.


This paper aimed to systematically describe the best available evidence for cerebral palsy interventions in 2019. We searched for the best available evidence published after 2012 and aggregated the new findings with our previous 2013 summary of evidence, using the updated GRADE system and the Evidence Alert Traffic Light System [5, 6]. The purpose of the paper was to describe what treatments have demonstrated evidence and highlight areas for more research. We rated the whole cerebral palsy intervention evidence base within the one paper to provide families, clinicians, managers, and policy makers with a helicopter view of best available intervention evidence to (a) inform decision-making by succinctly describing effective, emergent, and ineffective care; (b) aid comparative clinical decision-making about alike interventions and indications; and (c) provide a comprehensive resource to aid the creation of knowledge translation tools to promote evidence implementation.


We identified 182 interventions using our search strategy, an increase of 118 interventions from our 2013 review. Of these interventions, 41/182 (23%) were strategies aiming to prevent cerebral palsy and 141/182 (77%) were interventions aiming to manage cerebral palsy. The prevention strategies were categorized into antenatal prevention strategies (11/41, 27%) and neonatal prevention strategies (30/41, 73%). The interventions were categorized into allied heath interventions (83/141, 59%), pharmacological interventions (25/141, 18%), surgical interventions (19/141, 13%), regenerative medicine interventions (4/141, 3%), and complementary and alternative medicine (10/141, 7%). From these 182 interventions, we identified 393 intervention outcome indicators that had been studied in children with cerebral palsy. In five indications, two separate gradings were assigned, because the quality of the evidence was different in two sub-populations (e.g., ambulant versus non-ambulant) for the same intervention aim. This took the GRADE count by indication to a total of 398 indications.


High levels of evidence exist in the literature summarizing effective preventive strategies and intervention options for children with cerebral palsy. There was an exponential increase in the number of systematic reviews and clinical trials published about cerebral palsy interventions since our last review. We observed a substantial increase in the number of systematic reviews published about acupuncture, pharmacological agents for managing tone, orthopedic surgery, dysphagia management, physical activity, participation, and clinical trials in regenerative medicine.


In recent years, our understanding of the genetic basis for cerebral palsy has advanced substantially [253]. A genetic contribution is likely in one-third of all children with cerebral palsy, especially in those without traditional risk factors such as prematurity and hypoxia [253]. As our understanding of neurobiology and genomics expands, the revolutionized field will result in the development of new prevention and treatment targets [253]. Experts also predict that future neuroprotective interventions will take advantage of trimester-specific brain development knowledge and that development of novel treatments will be informed by advances in biomarkers of brain injury, genetics, and neuroimaging [254].


All children with cerebral palsy have, by definition, a motor impairment and difficulties with tasks involving motor performance [255]. In high-income countries, severity is lessening, and the rate of co-occurring epilepsy and intellectual disability is falling [2]. Three in four will now walk [2]. This decline in severity is encouraging. Children with cerebral palsy may be more likely than ever to be treatment responsive to motor interventions, because smaller brain injuries result in improved baseline motor, sensory, and perceptual skills and learning capabilities. Thus, understanding current evidence for effective motor interventions is critically important. There is now a clear dichotomy in the evidence base for what works and what does not for improving function and performance of tasks. Substantive clinical trial data support the efficacy of training-based interventions, including action observation training [20, 21], bimanual training [54,55,56], constraint-induced movement therapy [46, 62,63,64,65,66,67], functional chewing training [137], goal-directed training [98], home programs using goal-directed training [112], mobility training [123, 127], treadmill training [65, 123, 127], partial body weight support treadmill training [123, 127, 169], and occupational therapy post botulinum toxin [190] (green lights). Moreover, environmental enrichment to promote task performance is effective (green light) [95] and adapting the environment and task to enable task performance via context-focused therapy (yellow light) [77] is a potent modulator of effective care. All these interventions have the following features in common: practice of real-life tasks and activities, using self-generated active movements, at a high intensity, where the practice directly targets the achievement of a goal set by the child (or a parent proxy if necessary). The mechanism of action is experience-dependent plasticity [256]. Motivation and attention are vital modulators of neuroplasticity, and successful task-specific practice is rewarding and enjoyable to children, producing spontaneously regular practice [256]. In stark contrast, bottom-up, generic, and/or passive motor interventions are less effective and sometimes clearly ineffective for improving function and movement for children with cerebral palsy. These include craniosacral therapy [239,240,241], hyperbaric oxygen [234, 235], neurodevelopmental therapy in the original passive format [108, 129,130,131,132], and sensory integration [3] (red lights). When viewed through the lens of neuroplasticity, these results are logical. A passive experience of a movement, provided via a hands-on therapeutic approach from a carer or therapist, does not involve any child-initiated problem solving or any child activation of their motor circuity.


Against the backdrop of spasticity management, there is a now an intense research focus on improved understanding of pathology, histochemistry, and muscle architecture in cerebral palsy [257]. Children with cerebral palsy appear to have elevated proinflammatory cytokines and genes involved in the extracellular matrix of their skeletal muscles, combined with increased intramuscular collagen and reduced ribosomal production [258]. Newer understandings of these pathophysiological muscle changes have led some clinicians to call for a reconsideration of botulinum toxin treatment, which induces therapeutic weakness and potential muscle fibrosis [259]. We do not yet know whether the observed atrophy and insertion of replacement fat and connective tissue observed in muscles of children with cerebral palsy is the result of a direct or accelerated adverse event from botulinum toxin or whether these changes are the natural history of cerebral palsy. We anticipate that more research into muscle pathology will both alter treatment recommendations over time and, more importantly, lead to the discovery of new interventions. 350c69d7ab


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