Pediatric Physical Therapy:
An important report by Doralp and Bartlett1 appears in this issue that documents the prevalence of pain in adolescents with cerebral palsy (CP). This not the first time, attention has been brought to this problem2–5; yet with the data in hand from the work by Doralp and Bartlett,1 I believe that it is time to get serious about what our roles might be with respect to pain in this population.
In this issue, we also have a review article by Swiggum et al6 who outline an approach to the treatment of pain in children with CP. Their recommendations should provide some tools for therapists who do not routinely intervene to reduce pain in their young patients.
The thought that so many children with CP are seen by therapists who are trained to treat painful conditions raises the question “Do we ask children and teens with CP whether they are experiencing pain?” I would suggest that some may, but do we do this routinely? Developmental and functional tests are routine, as are tests to detect well-recognized impairments in range of motion, strength, and balance. I believe that it is time to determine whether the children under our care are experiencing pain, and if so we should begin to address pain as routinely as we might address weakness.
As Doralp and Bartlett point out, in some instances, pain can be prevented. However, I would suggest that we begin to examine in greater detail the mechanisms that lead to painful joints. Are the common postural malalignments and reduced movement repertoires leading to overuse and contributing to the development of pain, or is inactivity a culprit? Likely, both scenarios are operative in young persons with CP. With a better understanding of what leads to the development of pain, we can begin to prevent the development of pain as a secondary complication of an already complex disabling condition in children. Although I am sure that we can routinely begin to address pain in our examinations and interventions, ideally we need to prevent this secondary impairment before it begins to affect the quality of patients' lives.
Ann F. Van Sant, PT, PhD, FAPTA
1. Doralp S, Bartlett DJ. The prevalence, distribution, and impact of pain among adolescents with cerebral palsy. Pediatr Phys Ther
2. Campbell SK. Therapy programs for children that last a lifetime. Phys Occup Ther Pediatr
3. Gajdoskik CG, Cicirello N. Secondary conditions of the musculoskeletal system in adolescents and adults with cerebral palsy. Phys Occup Ther Pediatr
4. Dickinson HO, Parkinson KN, Ravens-Sieberer U, et al. Self-reported quality of life of 8–12 year old children with cerebral palsy: a cross sectional European study. Lancet
5. Berrin SJ, Malcarne VL, Varni JW, et al. Pain, fatigue, and school functioning in children with cerebral palsy: a path-analytic model. J Pediatr Psychol
6. Swiggum M, Hamilton ML, Gleeson P, et al. Pain in children with cerebral palsy: implications for pediatric physical therapy. Pediatr Phys Ther