CLINICAL BOTTOM LINE
“How could I apply this information?”
Children with neuromuscular disabilities often require intervention to improve body function and structural limitations in the muscular system. Interventions may include casting, active and passive range of motion, day and night-time splinting/orthoses, and standing programs. Through a comprehensive search and appraisal of the available evidence, this systemic review (SR) provides clinical recommendations for stretch interventions and suggests that none of the above-stated interventions has been demonstrated to be detrimental to children. Clinicians may infer from these findings that the intervention they choose should be individualized on the basis of the patient's specific musculoskeletal limitations, past successful interventions, and patient and family adherence. Limiting pain and adverse reactions would be ideal, but may impede the success of the intervention applied. On the basis of the results of this SR, patients will likely experience the most success with a combination of interventions that address passive range of motion through casting, gait kinematics and kinetics through orthoses, and bone mineral density through a standing program.
“What should I be mindful about when applying this information?”
This SR only included studies that had isolated interventions and excluded studies that would have addressed the effectiveness of short- or long-term stretching interventions after a medical intervention, such as botulinum toxin type A injections. The effect of concurrent therapeutic or medical interventions would likely change the outcome on function and the applicability of this SR's findings. This could be a topic for further research. It would also be helpful to stratify subjects by functional mobility level to measure the effect on outcomes. Studies included in the SR contained a range of diagnoses, some more specific (eg, Charcot Marie Tooth) than others (eg, cerebral palsy), leading to findings that may impact clinical decision making in varied ways. These differences in diagnostic categories should be taken into consideration by clinicians when applying these findings.
Samantha Gorrell, PT, DPT
Eric S. Pelletier, PT, DPT, PCS
University of the Sciences