Efficacy of occupational therapy and serial casting in lower limbs of cerebral palsy children administered with phenol nerve block

The effects of serial casting on lower limb function for children with Cerebral Palsy: a systematic review with meta-analysis

“…all children diagnosed with CP) from which they were recruited (item #11) and to the same manner, no subjects who participated, represented the entire population from which they were recruited (item #12). Nine studies were deemed to have poor methodological quality [29,47,50,51,[54][55][56][57]59], eleven studies were deemed to have fair methodological quality [15, 16, 22, 28, 39, 44-46, 49, 53, 58] and five studies were found to have good methodological quality [11,31,48,52,60]. When critically appraising the internal validity of studies, items relevant to the recruitment period of participants (item #22), blinding to randomized assignment (item #24) and adjustment for confounding variables (item #25) were all major contributors impacting the methodological quality studies included in this systematic review.…”

“…Effects of serial casting on particular outcomes were not included in meta-synthesis when the associated studies did not meet the threshold for methodological quality or when the required number of investigations for a particular outcome to be included was not met, and consequently the outcome measures that were not included in meta-synthesis comprised multiple body structure or function measures as well as activity and participation level outcomes. The body structure and function measures that were not included in meta-synthesis were: knee extension PROM [50,52,55,56], hip abduction PROM [51], Thomas Test [51], knee PROM (popliteal angle) [50,51], ankle dorsiflexion AROM [58], knee extension AROM [56], ankle angle at initial foot contact [46,49], Modified Ashworth Scale (MAS) assessing the hamstrings [52,56], Ashworth Scale (not modified) [46], velocity of passive stretch [29,44], Tardieu Scale (not modified) [11], Modified Tardieu Scale R1 angle ankle DF [54], dynamic assessment of ROM (DROM) [50], reflex excitability [29,44], isometric plantar flexion (PF) strength [44] and Physiological Cost Index (PCI) [45]. Activity or participation level measures that were not included were: gait velocity [45], gait-related cadence [39,52], WeeFim mobility scale [58], the Berg Balance Test [56] and Paediatric Evaluation of Disability Inventory (PEDI) [52].…”

“…1). After applying inclusion and exclusion criteria, 25 articles remained [11,15,16,22,28,29,31,39,[44][45][46][47][48][49][50][51][52][53][54][55][56][57][58][59][60]. Collectively 414 children undergoing serial casting (mean age: 5.6 years) were included with 476 limbs assessed across all studies.…”

“…Adverse events from utilising combined BTX-A and casting were noted in two studies and included: Lower limb weakness (n = 12); Pain (n = 3); Lower limb atrophy (n = 12); Temporary incontinence (n = 3); Constipation (n = 1); Pressure sores (n = 1) and; Tendonitis (n = 1). Nine of the included studies [28,39,44,45,50,54,[56][57][58] did not report adverse effects of the intervention in their manuscripts and a further four studies [29,31,52,60] stated that there were 'not adverse events' during their interventions.…”