Aim The aim of this study was to describe systematically the best available intervention evidence for children with cerebral palsy (CP). Method This study was a systematic review of systematic reviews. The following databases were searched: CINAHL, Cochrane Library, DARE, EMBASE, Google Scholar MEDLINE, OTSeeker, PEDro, PsycBITE, PsycINFO, and speechBITE. Two independent reviewers determined whether studies met the inclusion criteria. These were that (1) the study was a systematic review or the next best available; (2) it was a medical/allied health intervention; and (3) that more than 25% of participants were children with CP. Interventions were coded using the Oxford Levels of Evidence; GRADE; Evidence Alert Traffic Light; and the International Classification of Function, Disability and Health. Results Overall, 166 articles met the inclusion criteria (74% systematic reviews) across 64 discrete interventions seeking 131 outcomes. Of the outcomes assessed, 16% (21 out of 131) were graded ‘do it’ (green go); 58% (76 out of 131) ‘probably do it’ (yellow measure); 20% (26 out of 131) ‘probably do not do it’ (yellow measure); and 6% (8 out of 131) ‘do not do it’ (red stop). Green interventions included anticonvulsants, bimanual training, botulinum toxin, bisphosphonates, casting, constraint‐induced movement therapy, context‐focused therapy, diazepam, fitness training, goal‐directed training, hip surveillance, home programmes, occupational therapy after botulinum toxin, pressure care, and selective dorsal rhizotomy. Most (70%) evidence for intervention was lower level (yellow) while 6% was ineffective (red). Interpretation Evidence supports 15 green light interventions. All yellow light interventions should be accompanied by a sensitive outcome measure to monitor progress and red light interventions should be discontinued since alternatives exist.

OBJECTIVE: To summarize evidence on the rates of co-occurring impairments, diseases, and functional limitations with cerebral palsy into succinct clinical messages. METHODS:A search was conducted of the databases PubMed, Medline, CINAHL, and PsycINFO, and the results were supplemented with hand searches. Two independent reviewers determined whether retrieved abstracts met the following inclusion criteria: human subjects; .90% were children or adults with cerebral palsy; published after 1999; and population-based data. Articles were appraised, analyzing design, participants, level of evidence, rates of impairments, and functional implications. Methodologic quality was rated by using a standardized checklist. RESULTS:A total of 1366 papers were identified in the search; 82 were appraised and 30 were included in the meta-analyses. High-level evidence existed, as rated on the Oxford 2011 Levels of Evidence: 97% of prevalence studies were level 1. The data were of a moderate to high quality grade (with the exception of sleep disorders), allowing plain English clinical messages to be developed. CONCLUSIONS:Among children with cerebral palsy, 3 in 4 were in pain; 1 in 2 had an intellectual disability; 1 in 3 could not walk; 1 in 3 had a hip displacement; 1 in 4 could not talk; 1 in 4 had epilepsy; 1 in 4 had a behavior disorder; 1 in 4 had bladder control problems; 1 in 5 had a sleep disorder; 1 in 5 dribbled; 1 in 10 were blind; 1 in 15 were tube-fed; and 1 in 25 were deaf. Pediatrics 2012;130:e1285-e1312

AIM The aim of this study was to conduct a systematic review in order to identify the risk factors for cerebral palsy (CP) in children born at term. The secondary aim was to ascertain if the potential for prevention of these risk factors has been adequately explored.METHOD A MEDLINE search up to 31 July 2011 was completed, following the Meta-Analysis of Observational Studies in Epidemiology guidelines. Publications were reviewed to identify those with both a primary aim of identifying risk factors for all children or term-born children with CP and a cohort or case-control study design. Studies were examined for potential chance or systematic bias. The range of point estimates of relative risk is reported.RESULTS From 21 articles meeting inclusion ⁄ exclusion criteria and at low risk of bias, data from 6297 children with CP and 3 804 791 children without CP were extracted. Ten risk factors for termborn infants were statistically significant in each study: placental abnormalities, major and minor birth defects, low birthweight, meconium aspiration, instrumental ⁄ emergency Caesarean delivery, birth asphyxia, neonatal seizures, respiratory distress syndrome, hypoglycaemia, and neonatal infections. Strategies for possible prevention currently exist for three of these.INTERPRETATION Ten consistent risk factors have been identified, some with potential for prevention. Efforts to prevent these risk factors to interrupt the pathway to CP should be extended.Cerebral palsy (CP) is the most common physical disability of childhood. CP describes a group of disorders of movement and posture that are also often accompanied by associated impairments and secondary musculoskeletal problems. Term-born children account for 50 to 65% of children with CP, and they tend to be more severely impaired than children with CP born preterm.2 Moreover, the severity of disability in the term-born group seems to be increasing. 3 The incidence of CP among term-born infants ranges between 1 and 1.7 per 1000 live births, suggestive of a rare outcome.2-5 However, with 130 million infants born worldwide each year, 6 93% of whom are born at term, such incidence rates suggest that between 120 000 and 217 600 new cases of CP occur each year among term-born children, making this an important yet under-researched group with chronic lifelong disability.Over the past 50 years real progress has been made in the conceptual understanding of the aetiology of CP. We have confirmed that sentinel events around birth are responsible for a small proportion of CP. More typically, risk factors and multiple events interact in a cascade with additive effects. 7,8 However, despite the progress in conceptual understanding, there has been no discernible decrease in overall rates. Therefore, we asked what clinically meaningful messages could be drawn from the literature of the last 50 years to guide us towards prevention in the coming decades. The research questions for this study were (1) 'What risk factors for CP have been identified in the literature for infants born at...