No pain, no gain? Children with cerebral palsy and their experience with physiotherapy

Houx, Laëtitia; Pons, Christelle; Saudreau, Hélène; Dubois, Amandine; Creusat, Mathilde; Moine, Philippe; Rémy-Néris, Olivier; Ropars, Juliette; LeReste, Jean-Yves; Brochard, Sylvain

doi:10.1016/j.rehab.2020.10.002

Cited by 10 publications

(8 citation statements)

References 39 publications

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“…AESI frequency was very low and the most common was mechanical swelling, especially in the active group. Pain from sleeve wearing frequency was very low and not in accordance with the concept of "No pain, no gain" previously described (43). The AESI Itchy contact dermatitis was also very low, provoking some minor skin irritations.…”

Section: Discussionmentioning

confidence: 56%

Safety and adherence of pressure garment therapy in children with upper limb unilateral cerebral palsy. Results from a randomized clinical trial ancillary analysis

et al. 2023

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BackgroundThis study was conducted to assess the safety and adherence of the use of a PGT (Pressure Garment Therapy) Lycra® sleeve to treat upper limb unilateral cerebral palsy (UCP) in children.MethodsThis study was conducted as a prospective, placebo-controlled, double-blinded, randomized monocenter study. Included in the study were 58 UCP children, 49 of whom were analyzed. 25 children (mean age 6.6 ± 1.6 years; 12 girls) were allocated to the active group vs. 24 (mean age 6.7 ± 1.6 years; 10 girls) in the placebo group. The intervention consisted of an active PGT Lycra® arm sleeve manufactured to generate a homogeneous pressure ranging from 15 to 25 mmHg. The placebo PGT Lycra® sleeve was manufactured to generate a homogeneous pressure under 7 mmHg. The time of wearing period was set at 3 h/day at minimum and 6 h/day at maximum, over the course of 6 months. The main outcome measures were safety outcomes including the number and intensity of Adverse Events of Special Interest (AESIs). AESIs were defined as adverse events imputable to compressive therapy and Lycra® wearing. Level of adherence was expressed in percentage of number of days when the sleeve was worn for at least 3 h per day compared to length of duration in days (start and end date of wearing period).ResultsFrequency of AESIs were very low and no different between groups (4.12 ± 11.32% vs. 1.83 ± 3.38%; p = 0.504). There were no differences in adherence (91.86 ± 13.86% vs. 94.30 ± 9.95%; p = 0.425).ConclusionThe use of PGT Lycra® arm sleeve in children with UCP is safe and well-tolerated with a very good adherence. The low rate of AESIs is promising for further randomized clinical trials on efficacy.

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Section: Discussionmentioning

confidence: 56%

Safety and adherence of pressure garment therapy in children with upper limb unilateral cerebral palsy. Results from a randomized clinical trial ancillary analysis

et al. 2023

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“…The effects of SRP on children with CP should be considered as a cornerstone for participation, which is often underestimated. SRP can prevent a child with CP from performing usual daily activities and, importantly, from the physiotherapy and strenuous exercise that are vital parts of CP therapy [43][44][45]. The overall consequences can feed a vicious cycle of less movement, changes in muscle…”

Section: Discussionmentioning

confidence: 99%

Spasticity-related pain in children/adolescents with cerebral palsy. Part 2: IncobotulinumtoxinA efficacy results from a pooled analysis

Bonfert

Heinen

Kaňovský

et al. 2023

PRM

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PURPOSE: This pooled analysis of data from three Phase 3 studies investigated the effects of incobotulinumtoxinA on spasticity-related pain (SRP) in children/adolescents with uni-/bilateral cerebral palsy (CP). METHODS: Children/adolescents (ambulant and non-ambulant) were evaluated for SRP on increasingly difficult activities/tasks 4 weeks after each of four incobotulinumtoxinA injection cycles (ICs) using the Questionnaire on Pain caused by Spasticity (QPS; six modules specific to lower limb [LL] or upper limb [UL] spasticity and respondent type [child/adolescent, interviewer, or parent/caregiver]). IncobotulinumtoxinA doses were personalized, with all doses pooled for analysis. RESULTS: QPS key item responses were available from 331 and 155 children/adolescents with LL- and UL-spasticity, respectively, and 841/444 (LL/UL) of their parents/caregivers. IncobotulinumtoxinA efficacy was evident with the first IC. Efficacy was sustained and became more robust with further subsequent ICs. By week 4 of the last (i.e. fourth) IC, 33.8–53.3% of children/adolescents reported complete SRP relief from their baseline pain for respective QPS items. Children/adolescents reported reductions in mean LL SRP intensity at levels that surpassed clinically meaningful thresholds. Similarly, parents/caregivers observed complete SRP relief and less frequent SRP with incobotulinumtoxinA. Similar results were found for UL SRP. CONCLUSION: These findings indicate that incobotulinumtoxinA could bring considerable benefit to children/adolescents with spasticity by reducing SRP, even during strenuous activities.

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“…The International Pain Association describes the pain as "an unpleasant emotional and sensory experience linked with potential or actual damage of tissues". 3,4 Ache is also defined clinically as "a disorganized feeling that causes sorrow or misery." Both definitions agree that pain is a subjective experience that cannot be described.…”

Section: Introductionmentioning

confidence: 99%

Pain Assessment and Management of Neurologic Impairments by Pediatric Physical Therapists; A Cross-Sectional Survey

Kashif

Tariq²

2022

THJ

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Background: Physical therapists indicated the use of standardized pain assessment instruments like subjective measures, self-reported scales, behavioral and physiological measures to assess pain in children with neurological impairments. Indicators such as diminished attention, retreat, and changes in sleeping and feeding patterns were also reported along with facial expression, sobbing, and vocalizations. Therapists' perspectives on behavioral pain expressions may be significantly different from the perspectives of the children's parents or caregivers. Objective: To determine the methods of pain assessment and management for children with neurologic impairments used by pediatric physical therapists. Methods: A cross-sectional survey in which the data was collected from different public hospitals in Faisalabad, Pakistan. Convenient sampling was applied to recruit physiotherapists for this study and data was gathered through a structured questionnaire after taking their written informed consent. Results: Frequently used behaviors included facial expression, vocalizations, and irritability. Cues that were rarely used included changes in sleeping, withdrawal, eating behaviors, and decreased attention. Physiotherapists prefer to use pain interventions that were supported by research like praise and distraction as well as distress-producing potentially harmful measures such as reassurance and procedural talk. About 84% percent of the respondents used subjective measures to assess pain, 60% used self-report scales, and 32% used behavioral and physiological measures. The results regarding procedural explanation showed that 41.1% of physiotherapists had very often done procedural explanation and 58.9% had often done it. Conclusion: A well-structured practice pattern of pain assessment and treatment of neurologic deficits was observed among pediatric physical therapists. Praise, distraction, and procedural explanation were often used to ease discomfort and pain while doing physiotherapy treatment sessions. Overt signs such as vocalizations, weeping and facial expressions were used to measure pain more often than subtle markers such as lower attention, disengagement, and disturbed sleep and feeding habits.

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No pain, no gain? Children with cerebral palsy and their experience with physiotherapy

Cited by 10 publications

References 39 publications

Safety and adherence of pressure garment therapy in children with upper limb unilateral cerebral palsy. Results from a randomized clinical trial ancillary analysis

Safety and adherence of pressure garment therapy in children with upper limb unilateral cerebral palsy. Results from a randomized clinical trial ancillary analysis

Spasticity-related pain in children/adolescents with cerebral palsy. Part 2: IncobotulinumtoxinA efficacy results from a pooled analysis

Pain Assessment and Management of Neurologic Impairments by Pediatric Physical Therapists; A Cross-Sectional Survey

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