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|Title:||Dynamic elastomeric fabric orthosis in managing shoulder subluxation in children with severe cerebral palsy : a case series||Authors:||Lewis, J
|Issue Date:||2016||Publisher:||Wiley-Blackwell||Source:||Developmental medicine and child neurology, 2016, v. 58, p. 61 How to cite?||Journal:||Developmental medicine and child neurology||Abstract:||Objective: Dynamic elastomeric fabric orthoses (DEFO) madeof Lycraâis one type of orthoses prescribed for children withcerebral palsy (CP). Low level evidence, mostly case reportsand case series, has shown their effectiveness in managingabnormal muscle tone in children with CP. No study has beenconducted to speciﬁcally examine the effectiveness of theDEFO in managing shoulder subluxation in children with sev-ere CP. The purpose of this pilot study was to assess theeffect of the DEFO in the management of shoulder instabilityin children with CP, GMFCS levels IV and V.
Design: Multiple single subject design with multiple baselinerepeated measurements.
Method: Three children recruited through the Cerebral Palsyand Movement Disorders Service (CHW). Participant 1: 16 years, female, dystonic quadriplegia, GMFCS IV, MACSIII; Participant 2: 6½ years, male, dystonic quadriplegia,GMFCS level IV, MACS level IV; Participant 3: 11 years,male, dyskinetic quadriplegia, GMFCS level IV, MACS levelIII. Three baseline assessments were completed. The interven-tion phase continued for 12 months. Repeated assessmentswere performed at 3, 6, 9 and 12 months post-provision ofthe DEFO. The assessment included distance from the tip ofacromion process to humeral head (mm); shoulder passiverange of motion; Participant/Parent evaluation (rating scale);Care and Comfort Hypertonicity Questionnaire and a diarylog of compliance. All standard care including botulinumtoxin-A (BTX-A) injections continued.
Results: All participants reported improvement in pain and dis-comfort when wearing the DEFO at rest and/or during theidentiﬁed activities, especially around the time of BTX-A.Two participants showed improved shoulder enlocation dur-ing periods of consistent wearing. No participant completedthe 12 month intervention period due to: failure to wear dur-ing summer months (heat and rubbing), complex medicalissues, and Deep Brain Stimulation implantation surgery (Par-ticipant 3). No change trend was seen in the overall meanscore in the Care and Comfort Hypertonicity Questionnaire.
Conclusion: This study shows inconclusive evidence that theDEFO was effective in managing shoulder instability in chil-dren with severe CP due to the small sample size and poorretention of participants. Improved shoulder enlocation anddecreased pain and discomfort at rest and/or on activity whenworn were noted, however all participants discontinued wear-ing the garment for various reasons. Further rigorous studieswith larger sample sizes and studying less medically complexpatient group/s is recommended to gain further knowledge ofthis intervention to help guide evidence-based practice inusing this type of intervention.
|Description:||Biennial Conference of the Australasian Academy of Cerebral Palsy and Developmental Medicine (8th: 2016), Adelaide, Australia, 30 March – 2 April 2016||URI:||http://hdl.handle.net/10397/76829||ISSN:||0012-1622||EISSN:||1469-8749|
|Appears in Collections:||Journal/Magazine Article|
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