Guideline to improve physical function in cerebral palsy: too big to succeed

Abstract

This letter to the editor is on the Clinical Practice Guide by Jackman et al. on pages 536–549 of this issue.

The Bobath Clinical Reasoning Framework: A systems science approach to the complexity of neurodevelopmental conditions, including cerebral palsy

“…8,34,35 Because of a lack of methodological rigour, randomized controlled trials and systematic reviews should be viewed with caution to understand effective treatments. 36,37 Research into a complex disorder like CP, which often requires a combination of different intervention ingredients for different individuals, is challenging; 24,30,37 as suggested in this review, a reductionist or linear approach to intervention is inadequate in addressing the complexity of the disorder. Testing the non-linear, systems thinking-based clinical reasoning used by the BCRF raises many challenges and requires a different approach from the use of randomized F I G U R E 6 Therapeutic handling (TH) was key in assisting this young person to achieve the goal of sitting comfortably, which also enabled safe eating and drinking, improved breath control for voice for communication, and the opportunity to go out in her buggy with friends (Appendix S2, clinical case study 2).…”

“…While these have been developed with the intention of making decisions about intervention choices easier for clinicians, the traffic light alert system is an oversimplification 8,34,35 . Because of a lack of methodological rigour, randomized controlled trials and systematic reviews should be viewed with caution to understand effective treatments 36,37 …”

Best evidence for improving function in children with cerebral palsy: Success is within reach

“…EDITOR-We agree with Romeiser Logan and Kolaski that the cerebral palsy (CP) evidence base is imperfect, with numerous low-quality studies and insufficient sample sizes lacking long-term effectiveness data. 1 However, we cannot pause clinical practice until perfect evidence is available. The aim of evidence-based practice for clinicians and families is to 'pay due respect-no more, no less-to current best evidence in making decisions'.…”

Le cadre de raisonnement clinique Bobath: un modèle de science des systèmes pour aborder la complexité des troubles neurodéveloppementaux, y compris la paralysie cérébrale

“…8,34,35 Les essais contrôlés randomisés et les revues systématiques doivent être considérés avec prudence lorsqu'il s'agit de comprendre l'efficacité des traitements. 36,37 L'étude d'un trouble complexe comme la PC, qui nécessite souvent une combinaison de différents ingrédients d'intervention pour différents individus, est difficile. 24,30,37 comme le suggère cette revue, une approche réductionniste ou linéaire de l'intervention est inadéquate pour aborder la complexité du trouble.…”