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Cole, Andrew OTR/L, BCP, BOccThy; Cox, Talitha OTR/L, MOT

American Journal of Physical Medicine & Rehabilitation: May 1, 2019 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/PHM.0000000000001212
Literature Review: PDF Only

Objective The aim of this review is to identify treatment strategies in the research literature to inform all health professionals on best practice strategies when addressing GHS.

Design Articles were identified by searching electronic databases. Two reviewers independently appraised the methodological quality of the selected studies. Discrepancies were resolved following corroboration of results.

Results Research literature pertaining to five major treatment strategies was found (n=40 peer-reviewed publications), spanning evidence Levels I-V. The greatest number of studies concerned neuromuscular electrical stimulation (NMES; n=19), five of which were Level I studies, followed by manual preventive strategies such as slings (n=20), three of which were Level I studies.

Conclusion These findings indicate that the most high-quality research supports using NMES or manual preventive studies, although no studies used direct comparison methods to ascertain relative merits of each type of intervention when compared to others. No evidence suggested that harm was done by utilizing NMES or manual preventive methods. This literature review suggests the identified treatment strategies should be considered by clinicians as the treatment of choice for GHS. No literature was identified that reviewed treatment strategies in a pediatric population; however the authors considerations for treatment in the pediatric population were included.

Children’s Hospital Los Angeles, Division of Pediatric Rehabilitation Medicine, Los Angeles, California, United States of America

ADDRESS FOR CORRESPONDENCE: Andrew Cole OTR/L, BCP, Children’s Hospital Los Angeles, Division of Pediatric Rehabilitation Medicine, 4650 Sunset Blvd., #56, Los Angeles, CA 90027 USA. Tel.: +1 (323) 361-2118; Fax: +1 (323) 361-8032; Email:,

ACKNOWLEDGEMENTS: We are very grateful to Children’s Hospital Los Angeles Division of Rehabilitation who initiated and provided protected time for the developmental of the evidence-based tool, specifically Bryant Edwards OTD, MA, OTR/L, BCP, MPH. Special thanks are also given to Susan Rethlefsen PT, DPT, Bianca Mendonca PT, DPT, Kimberly Loffredo OTR/L, CBIS & Jennifer Bashar OTD, OTR/L, BCPR, CBIS for their valuable feedback for this review. Meaningful contributions were also provided by Jill Blitz PT, DPT, ATP, Julie Werner PhD, OTR/L, CHT, Jamie Beggren OTR/L and Rubi Buxton PT, DPT.

CONFLICT OF INTEREST; The authors declare that no conflict of interest exists.

FUNDING & DISCLOSURE; The authors of this manuscript, Andrew Cole and Talitha Cox, have nothing to disclose. No funding was received for this review.

Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.