Dataset Information

Gastrostomy feeding in cerebral palsy: a systematic review.

ABSTRACT:

Aims

To determine benefits and risks for gastrostomy or jejunostomy feeding compared with oral feeding for children with cerebral palsy.

Methods

Systematic review.

Search strategy

electronic databases--Cochrane Library, Medline, Embase, Cinahl, Lilacs, databases of theses, grey literature. INCLUDED: relevant systematic reviews, randomised controlled trials, observational studies, case reports. EXCLUDED: non-systematic reviews and qualitative research.

Participants

children with cerebral palsy.

Intervention

use of gastrostomy or jejunostomy tube to provide nutrition.

Outcome

evaluated outcome measures included death, growth, gastro-oesophageal reflux, other complications, psychosocial aspects, and caregiver wellbeing.

Results

No relevant systematic reviews or randomised controlled trials were found. Two cohort studies, 15 case series, and eight case reports met the inclusion criteria. Eight studies specifically described percutaneous endoscopic gastrostomy as the intervention. Weight gain resulted from gastrostomy feeding in most cases. There was an approximately fourfold increased risk of death reported in one cohort study for the gastrostomy fed children. Many complications were reported, including potential for increased gastro-oesophageal reflux and fluid aspiration into the lungs.

Conclusions

Benefits associated with gastrostomy or jejunostomy feeding are difficult to assess from the available evidence. Risks of gastrostomy, particularly in relation to surgical complications, have been described but the size of the risk could not be quantified. The finding of a higher death rate for children fed by gastrostomy may merely reflect the greater disability of these compared with orally fed children. Lack of available evidence and the substantial risk of bias in observational studies suggests that a well conducted randomised controlled trial of sufficient size will be needed to answer these problems.

SUBMITTER: Sleigh G

PROVIDER: S-EPMC1719963 | biostudies-literature | 2004 Jun

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Gastrostomy feeding in cerebral palsy: a systematic review.

Sleigh G G Brocklehurst P P

Archives of disease in childhood 20040601 6

<h4>Aims</h4>To determine benefits and risks for gastrostomy or jejunostomy feeding compared with oral feeding for children with cerebral palsy.<h4>Methods</h4>Systematic review.<h4>Search strategy</h4>electronic databases--Cochrane Library, Medline, Embase, Cinahl, Lilacs, databases of theses, grey literature. INCLUDED: relevant systematic reviews, randomised controlled trials, observational studies, case reports. EXCLUDED: non-systematic reviews and qualitative research.<h4>Participants</h4>ch ...[more]

PMID: 15155398

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Project description:BackgroundThis review aims to explore advances in the field of cerebral palsy (CP) focusing on machine learning (ML) models. The objectives of this study is to analyze the advances in the application of ML models in the field of CP and to compare the performance of different ML algorithms in terms of their effectiveness in CP identification, classifying CP into its subtypes, prediction of abnormalities in CP, and its management. These objectives guide the review in examining how ML techniques are applied to CP and their potential impact on improving outcomes in CP research and treatment.MethodologyA total of 20 studies were identified on ML for CP from 2013 to 2023. Search Engines used during the review included electronic databases like PubMed for accessing biomedical and life sciences, IEEE Xplore for technical literature in computer, Google Scholar for a broad range of academic publications, Scopus and Web of Science for multidisciplinary high impact journals. Inclusion criteria included articles containing keywords such as cerebral palsy, machine learning approaches, outcome response, identification, classification, diagnosis, and treatment prediction. Studies were included if they reported the application of ML techniques for CP patients. Peer reviewed articles from 2013 to 2023 were only included for the review. We selected full-text articles, clinical trials, randomized control trial, systematic reviews, narrative reviews, and meta-analyses published in English. Exclusion criteria for the review included studies not directly related to CP. Editorials, opinion pieces, and non-peer-reviewed articles were also excluded. To ensure the validity and reliability of the findings in this review, we thoroughly examined the study designs, focusing on the appropriateness of their methodologies and sample sizes. To synthesize and present the results, data were extracted and organized into tables for easy comparison. The results were presented through a combination of text, tables, and figures, with key findings emphasized in summary tables and relevant graphs.ResultsRandom forest (RF) is mainly used for classifying movements and deformities due to CP. Support vector machine (SVM), decision tree (DT), RF, and K-nearest neighbors (KNN) show 100% accuracy in exercise evaluation. RF and DT show 94% accuracy in the classification of gait patterns, multilayer perceptron (MLP) shows 84% accuracy in the classification of CP children, Bayesian causal forests (BCF) have 74% accuracy in predicting the average treatment effect on various orthopedic and neurological conditions. Neural networks are 94.17% accurate in diagnosing CP using eye images. However, the studies varied significantly in their design, sample size, and quality of data, which limits the generalizability of the findings.ConclusionClinical data are primarily used in ML models in the CP field, accounting for almost 47%. With the rise in popularity of machine learning techniques, there has been a rise in interest in developing automated and data-driven approaches to explore the use of ML in CP.

Project description:BACKGROUND:In this systematic review we investigate which instrumented measurements are available to assess motor impairments, related activity limitations and participation restrictions in children and young adults with dyskinetic cerebral palsy. We aim to classify these instrumented measurements using the categories of the international classification of functioning, disability and health for children and youth (ICF-CY) and provide an overview of the outcome parameters. METHODS:A systematic literature search was performed in November 2019. We electronically searched Pubmed, Embase and Scopus databases. Search blocks included (a) cerebral palsy, (b) athetosis, dystonia and/or dyskinesia, (c) age 2-24 years and (d) instrumented measurements (using keywords such as biomechanics, sensors, smartphone, and robot). RESULTS:Our search yielded 4537 articles. After inspection of titles and abstracts, a full text of 245 of those articles were included and assessed for further eligibility. A total of 49 articles met our inclusion criteria. A broad spectrum of instruments and technologies are used to assess motor function in dyskinetic cerebral palsy, with the majority using 3D motion capture and surface electromyography. Only for a small number of instruments methodological quality was assessed, with only one study showing an adequate assessment of test-retest reliability. The majority of studies was at ICF-CY function and structure level and assessed control of voluntary movement (29 of 49) mainly in the upper extremity, followed by assessment of involuntary movements (15 of 49), muscle tone/motor reflex (6 of 49), gait pattern (5 of 49) and muscle power (2 of 49). At ICF-CY level of activities and participation hand and arm use (9 of 49), fine hand use (5 of 49), lifting and carrying objects (3 of 49), maintaining a body position (2 of 49), walking (1 of 49) and moving around using equipment (1 of 49) was assessed. Only a few methods are potentially suitable outside the clinical environment (e.g. inertial sensors, accelerometers). CONCLUSION:Although the current review shows the potential of several instrumented methods to be used as objective outcome measures in dyskinetic cerebral palsy, their methodological quality is still unknown. Future development should focus on evaluating clinimetrics, including validating against clinical meaningfulness. New technological developments should aim for measurements that can be applied outside the laboratory.

Project description:BackgroundIn children, cerebral palsy (CP) is one of the most common causes of irreversible neurological sequelae. Acupotomy, a modernized acupuncture form combining the effects of microsurgery and conventional acupuncture, may show specific benefits in the treatment of CP, especially with respect to spasticity. The aim of this review was to evaluate the efficacy of acupotomy for CP.MethodsEleven databases were comprehensively searched from their inception dates to November 27, 2018. Randomized controlled trials (RCTs) or quasi-RCTs evaluating acupotomy as a monotherapy or as adjunctive therapy to rehabilitation treatment for CP were included. The methodological quality of included studies was assessed using the risk of bias tool. The quality of evidence for each main outcome was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation approach. Meta-analysis was performed, and the pooled data were presented as mean difference (MD) with 95% confidence interval (CI) for continuous outcomes and as risk ratio (RR) with 95% CI for dichotomous outcomes.ResultsEight studies involving 530 participants were included. In 1 study, acupotomy was associated with significantly higher total effective rate (TER) compared with Bobath (P < .01). Acupotomy combined with rehabilitation was associated with significantly higher TER (RR 1.24, 95% CI 1.01-1.52, I = 77%) and gross motor function measure score (MD 12.62, 95% CI 11.75-13.49, I = 54%), and significantly lower muscle tone of gastrocnemius measured by the Ashworth scale or the modified Ashworth scale (MD -0.97, 95% CI -1.07 to -0.88, I = 0%) compared with rehabilitation alone. No studies reported the incidence of adverse events. The methodological quality of the included studies and quality of evidence for the main finding were generally low.ConclusionCurrent evidence shows that acupotomy as a monotherapy or as adjunctive therapy to rehabilitation treatment might have benefits in the treatment of CP. However, due to the small number of studies included, the lack of sample size, poor methodological qualities, and low quality of evidence, the findings of this review should be interpreted with caution. Larger and more rigorous, high-quality RCTs should be performed on this topic.Prospero registration numberCRD42018105891.

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Project description:Unlabelled: Evidence for stem cells as a potential intervention for cerebral palsy is emerging. Our objective was to determine the efficacy and safety of stem cells for improving motor and cognitive function of people with cerebral palsy. Searches were conducted in October 2015 in CENTRAL, EMBASE, MEDLINE, and Cochrane Libraries. Randomized controlled trials and controlled clinical trials of stem cells for cerebral palsy were included. Two authors independently decided upon included trials, extracted data, quality, and risk of bias. The primary outcome was gross motor function. Secondary outcomes were cognitive function and adverse events (AEs). Effects were expressed as standardized mean differences (SMD) with 95% confidence intervals (CI), using a random-effects model. Five trials comprising 328 participants met inclusion criteria. Four cell types were studied: olfactory ensheathing, neural, neural progenitors, and allogeneic umbilical cord blood (UCBs). Transplantation procedures differed from central nervous system neurosurgical transplantation to intravenous/arterial infusion. Participants were followed short-term for only 6 months. Evidence of variable quality indicated a small statistically significant intervention effect from stem cells on gross motor skills (SMD 1.27; 95% CI 0.22, 2.33), with UCBs most effective. There were insufficient and heterogeneous data to compare cognitive effects. Serious AEs were rare (n = 4/135 [3%] stem cells; n = 3/139 [2%] controls). Stem cells appeared to induce short-term improvements in motor skills. Different types of stem cell interventions were compared, meaning the data were heterogeneous and are a study limitation. Further randomized controlled trials are warranted, using rigorous methodologies.SignificanceStem cells are emerging as a scientifically plausible treatment and possible cure for cerebral palsy, but are not yet proven. The lack of valid animal models has significantly hampered the scope of clinical trials. Despite the state of current treatment evidence, parents remain optimistic about the potential improvements from stem cell intervention and feel compelled to exhaust all therapeutic options, including stem cell tourism. Receiving unproven therapies from unvalidated sources is potentially dangerous. Thus it is essential that researchers and clinicians stay up to date. A systematic review and meta-analysis summarizing and aggregating current research data may provide more conclusive evidence to inform treatment decision making and help direct future research.

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Dataset Information

Gastrostomy feeding in cerebral palsy: a systematic review.

Aims

Methods

Search strategy

Participants

Intervention

Outcome

Results

Conclusions

Publications

Gastrostomy feeding in cerebral palsy: a systematic review.

Similar Datasets

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