SUBJECTS AND METHODS.

PURPOSE

RESULTS

BACKGROUND

Effectiveness of Neurodevelopmental Treatment on GMFM scores in Children with CP Tanja Argirovska-Hebert, Rhiannon Bailey, Kelly Coughlan and Alissa Engel

Purpose

Background

Methods of Review

Summary of Results

EBM Question

Conclusion

The purpose of this systematic review is to determine the strength of the evidence of Neuro-Developmental Treatment (NDT) on improvement of motor function in children with cerebral palsy (CP). Outcome measure is the Gross Motor Function Measure (GMFM).

Search Strategy•Four Databases: CINAHL, Medline, Open Door, Pedro•Total number of titles/abstracts identifiedSelection Process•Articles reviewed by 4 investigators, rejected if did not meet criteria•10 full text articles obtained and examined•5 articles met criteria and critically reviewed

Data Extraction and Validity Assessment•Standardized data extraction form; second reviewer examined for agreement•Standardized validity form•4 reviewer split in teams of 2. Articles were divided equally between the groups of 2. Each investigator reviewed each article assigned to their groups. Differences were resolved via consensus.

Level of Evidence and Recommendation GradeScotland National Health Service Criteria used

Does NDT sufficiently improve scores on the Gross Motor Function Measure for children with Cerebral Palsy?

Grade of Recommendation:

Application to Practice

Application to Future Research•Increased use of RCTs with double blinding and NDT application•Increased use of NDT with children 4 years and above

Methodological Quality of Studies•Participants ages 4 mos to 18 years•Cerebral Palsy type•Outcomes: GMFM•Types of studies: RCTs, case studies, grade, low/mod/high

Results by Outcome Measures•# with statistically + clinically sign•# with statistical (?)•# with neither

•CP affects 1.5-2 children in every 1,000 live births in the United States. • Bobath approach developed in the 1940s for the treatment of children with CP. This methodology has become the foundation of the NDT approach.• Updated systematic review required to elucidate strength of evidence on NDT for children with CP

Statistically significantClinically significantClinically and Statistically SignificantNeither Clinically or Statistically Significant

Author and Study DesignSample Size and Study Duration

GMFM Outcome

Arndt (2008) – Repeated measures randomized block designN=19 (10), 10 sessions over 15 days

+Statistical+Clinical

Bar-Haim (2006) - RCTN = 24, 20 sessions over 4 wks

+Statistical for 10 mo follow up-Statistical for mechanical efficiency index

Tsorlakis (2004) - RCTN = 34, 32 sessions over 16 wks

+Statistically significant+Clinically significant for 10 children in treatment group and 7 children in control group

Knox (2002) – repeated measures designN = 15, 36 sessions over 12 wks

+Statistically significant

Kerem (2002) – Quasi-experimentalN = 659, 5 years, 18 months treatment time

+Statistically significant pre & post intervention for late intervention+Statistically & Clinically significant pre & post intervention for early intervention