Excerpt

This guideline covers the management of spasticity and co-existing motor disorders and their early musculoskeletal complications in children and young people (from birth up to their 19th birthday) with non-progressive brain disorders.

Cerebral palsy is the most common condition associated with spasticity in children and young people. The incidence of cerebral palsy is not known, but its prevalence in the UK is 186 per 100,000 population, with a total of 110,000 people affected. The guideline covers the management of spasticity associated with cerebral palsy, but not all aspects of the management of cerebral palsy.

The impact of spasticity and co-existing motor disorders and their early musculoskeletal complications on the child or young person varies. Common problems include impaired motor function affecting the person's ability to participate in society, pain from muscle spasms, motor developmental delay and difficulties with daily care due to the onset of secondary complications of spasticity. Management should be tailored to meet the problems faced by the individual child or young person and their individual goals.

There is considerable variation in practice in managing spasticity, including variation in the availability of treatments and the intensity of their use. This guideline will help healthcare professionals to select and use appropriate treatments for individual children and young people.

Contents

• 1. Guideline summary
  • 1.1. Guideline development group membership, NCC-WCH staff and acknowledgements
  • 1.2. Foreword
  • 1.3. Care pathway
  • 1.4. Key priorities for implementation
  • 1.5. Recommendations
  • 1.6. Key research recommendations
  • 1.7. Research recommendations
  • 1.8. Schedule for updating the guideline
• 2. Introduction
  • 2.1. Spasticity and co-existing motor disorders
  • 2.2. For whom is this guideline intended?
  • 2.3. Related NICE guidance
• 3. Guideline development methodology
  • 3.1. Methodology
  • 3.2. Developing review questions and protocols and identifying evidence
  • 3.3. Reviewing and synthesising evidence
  • 3.4. Incorporating health economics
  • 3.5. Evidence to recommendations
  • 3.6. Stakeholder involvement
  • 3.7. Specific considerations for this guideline
• 4. Physical therapy (physiotherapy and/or occupational therapy)
  • Introduction
  • Review question
  • Description of included studies
  • Evidence profiles
  • Evidence statement
  • Other comparisons of interest
  • Health economics
  • Evidence to recommendations
  • Recommendations
• 5. Orthoses
  • Introduction
  • Review question
  • Description of included studies
  • Evidence profiles
  • Evidence statement
  • Other comparisons of interest
  • Health economics
  • Evidence to recommendations
  • Recommendations
• 6. Oral drugs
  • Introduction
  • Review question
  • Description of included studies
  • Evidence profiles
  • Evidence statement
  • Other comparisons of interest
  • Health economics
  • Evidence to recommendations
  • Recommendations
• 7. Botulinum toxin
  • Introduction
  • Review question
  • Description of included studies
  • Evidence profiles
  • Evidence statement
  • Other comparisons of interest
  • Health economics
  • Evidence to recommendations
  • Recommendations
• 8. Intrathecal baclofen
  • Introduction
  • Review questions
  • Description of included studies
  • Evidence profiles
  • Evidence statement
  • Health economics
  • Evidence to recommendations
  • Recommendations
• 9. Orthopaedic surgery
  • Introduction
  • Review questions
  • Description of included studies
  • Evidence profiles
  • Evidence statement
  • Other comparisons of interest
  • Health economics
  • Evidence to recommendations
  • Recommendations
• 10. Selective dorsal rhizotomy
  • Introduction
  • Review question
  • Description of included studies
  • Evidence profiles
  • Evidence statement
  • Other comparisons of interest
  • Health economics
  • Evidence to recommendations
  • Recommendations
• 11. Health economics
  • 11.1. Introduction
  • 11.2. Physical therapy (physiotherapy and/or occupational therapy)
  • 11.3. Orthoses
  • 11.4. Botulinum toxin
  • 11.5. Intrathecal baclofen
  • 11.6. Orthopaedic surgery
  • 11.7. Selective dorsal rhizotomy
  • 11.8. Overall conclusions
• 12. References
• 13. Abbreviations and glossary
• Appendix A. Scope
• Appendix B. Declarations of interest
• Appendix C. Stakeholders
• Appendix D. Review protocols
• Appendix E. Outcome measures
• Appendix F. Search strategies
• Appendix G. Summary of identified studies
• Appendix H. Excluded studies
• Appendix I. Evidence tables
• Appendix J. Forest plots
• Appendix K. GRADE tables
• Appendix L. Benefits and harms of intrathecal baclofen

While every effort has been made to ensure the accuracy of the information contained within this publication, the publisher can give no guarantee for information about drug dosage and application thereof contained in this book. In every individual case the respective user must check current indications and accuracy by consulting other pharmaceutical literature and following the guidelines laid down by the manufacturers of specific products and the relevant authorities in the country in which they are practising.

This guideline has been fully funded by NICE. Healthcare professionals are expected to take it fully into account when exercising their clinical judgement. However, the guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient.

Implementation of this guidance is the responsibility of local commissioners and/or providers.