Editing Cerebral palsy (section)

==Management==
[[File:Cerebral palsy.jpg|thumb|alt=A girl wearing leg braces walks towards a woman in a gym, with a treadmill visible in the background.| Researchers are developing an electrical stimulation device specifically for children with cerebral palsy, who have [[foot drop]], which causes tripping when walking.]]
{{Main|Management of cerebral palsy}}
Over time, the approach to CP management has shifted away from narrow attempts to fix individual physical problems {{endash}} such as spasticity in a particular limb {{endash}} to making such treatments part of a larger goal of maximizing the person's independence and community engagement.<ref name="novak_2013" />{{rp|886}}  However, the evidence base for the effectiveness of intervention programs reflecting the philosophy of independence has not yet caught up: effective interventions for body structures and functions have a strong evidence base, but evidence is lacking for effective interventions targeted toward participation, environment, or personal factors.<ref name="novak_2013" /> There is also no good evidence to show that an intervention that is effective at the body-specific level will result in an improvement at the activity level or vice versa.<ref name="novak_2013" /> Although such cross-over benefit might happen, not enough high-quality studies have been done to demonstrate it.<ref name="novak_2013" />

Because cerebral palsy has "varying severity and complexity" across the lifespan,<ref name="multidisciplinary455" /> it can be considered a collection of conditions for management purposes.<ref name="research gaps 2016" /> A [[multidisciplinary]] approach for cerebral palsy management is recommended,<ref name="multidisciplinary455" /> focusing on "maximising individual function, choice and independence" in line with the [[International Classification of Functioning, Disability and Health]]'s goals.<ref name="autogenerated1" /> The team may include a paediatrician, a [[health visitor]], a social worker, a physiotherapist, an orthotist, a speech and language therapist, an [[occupational therapist]], a teacher specialising in helping children with visual impairment, an educational psychologist, an [[orthopaedic surgeon]], a neurologist and a neurosurgeon.<ref>{{cite web |title=Cerebral palsy – Treatment |url=http://www.nhs.uk/Conditions/Cerebral-palsy/Pages/Treatment.aspx |website=www.nhs.uk |publisher=[[NHS Choices]] |access-date=6 February 2017 |url-status=live |archive-url=https://web.archive.org/web/20170206185635/http://www.nhs.uk/Conditions/Cerebral-palsy/Pages/Treatment.aspx |archive-date=6 February 2017}}</ref>

Various forms of therapy are available to people living with cerebral palsy as well as caregivers and parents. Treatment may include one or more of the following: physical therapy; occupational therapy; speech therapy; water therapy; drugs to control seizures, alleviate pain, or relax muscle spasms (e.g. [[benzodiazepine]]s); surgery to correct anatomical abnormalities or release tight muscles; [[orthotics|braces and other orthotic devices]]; rolling walkers; and communication aids such as computers with attached voice synthesisers.<ref name="ninds.nih.gov"/> Intensive rehabilitation is practiced in certain countries, but obtaining reliable data on its medium and long-term effectiveness is challenging.<ref>{{cite journal |vauthors=Ravault L, Darbois N, Pinsault N |title=Methodological Considerations to Investigate Dosage Parameters of Intensive Upper Limb Rehabilitation in Children with Unilateral Spastic Cerebral Palsy: A Scoping Review of RCTs |journal=Developmental Neurorehabilitation |volume=23 |issue=5 |pages=309–320 |date=July 2020 |pmid=31710245 |doi=10.1080/17518423.2019.1687599 |s2cid=207966055 |url=https://hal.archives-ouvertes.fr/hal-02889431/file/Ravault%2C%20Darbois%2C%20Pinsault_Scoping%20Review_Cerebral%20Palsy%20Dosage%20Intensive%20Rehabilitation%202019%20%281%29.pdf}}</ref>

Surgical intervention in CP children may include various [[orthopaedic surgery|orthopaedic]] or [[neurosurgery|neurological surgeries]] to improve quality of life, such as tendon releases, hip rotation, [[spinal fusion]], ([[selective dorsal rhizotomy]]) or placement of an [[intrathecal]] baclofen pump.<ref name="Amen2018" /><ref name="novak_2013" /><ref>Hallman-Cooper JL, Rocha Cabrero F. Cerebral Palsy. [Updated 2022 Oct 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK538147/</ref>

A Cochrane review published in 2004 found a trend toward the benefit of speech and language therapy for children with cerebral palsy but noted the need for high-quality research.<ref>{{cite journal |vauthors=Pennington L, Goldbart J, Marshall J |title=Speech and language therapy to improve the communication skills of children with cerebral palsy |journal=The Cochrane Database of Systematic Reviews |volume=2004 |issue=2 |pages=CD003466 |year=2004 |pmid=15106204 |pmc=8407241 |doi=10.1002/14651858.CD003466.pub2}}</ref> A 2013 systematic review found that many of the therapies used to treat CP have no good evidence base; the treatments with the best evidence are medications ([[anticonvulsant]]s, [[botulinum toxin]], [[bisphosphonate]]s, [[diazepam]]), therapy (bimanual training, [[Orthopedic cast|casting]], [[constraint-induced movement therapy]], context-focused therapy, fitness training, goal-directed training, hip surveillance, home programmes, occupational therapy after botulinum toxin, pressure care) and surgery. There is also research on whether the sleeping position might improve hip migration, but there are not yet high-quality evidence studies to support that theory.<ref>{{cite journal |vauthors=Blake SF, Logan S, Humphreys G, Matthews J, Rogers M, Thompson-Coon J, Wyatt K, Morris C |title=Sleep positioning systems for children with cerebral palsy |journal=The Cochrane Database of Systematic Reviews |volume=2015 |issue=11 |pages=CD009257 |year=2015 |pmid=26524348 |pmc=8761500 |doi=10.1002/14651858.CD009257.pub2}}</ref> Research papers also call for an agreed consensus on outcome measures which will allow researchers to cross-reference research. Also, the terminology used to describe orthoses<ref>{{cite journal |vauthors=Eddison N, Mulholland M, Chockalingam N |title=Do research papers provide enough information on design and material used in ankle foot orthoses for children with cerebral palsy? A systematic review |journal=Journal of Children's Orthopaedics |volume=11 |issue=4 |pages=263–271 |date=August 2017 |pmid=28904631 |pmc=5584494 |doi=10.1302/1863-2548.11.160256}}</ref> needs to be standardised to ensure studies can be reproduced and readily compared and evaluated.