The Case for Parent-Implemented Programs to Mitigate Musculoskeletal Complications in Children With Severe Cerebral Palsy in Resource-Limited Settings

INTRODUCTION

Cerebral palsy (CP) is a leading cause of childhood motor disability worldwide. Secondary musculoskeletal (MSK) complications of CP are common and can further incapacitate children functionally and restrict their participation in ordinary life. Conventional, comprehensive management approaches for preventing complications of CP require regular access to specialized and coordinated medical interventions, rehabilitation, and equipment, all of which may be scarce or unavailable in resource-limited settings (RLSs).¹ In this article, we present the case for a standardized home-based program aimed at preventing secondary MSK complications in children with severe CP living in RLSs.

The current birth prevalence of CP in low- and middle-income countries (LMICs) is estimated to be as high as 3.4 per 1000 births, compared to 1.6 per 1000 live births in high-income countries (HICs).² Due to differences in maternal and perinatal health and the particular risk factors for CP in LMICs, these countries also tend to have higher proportions of children with more severe subtypes of CP,³ including bilateral spastic and dyskinetic presentations^4–7 (i.e., more children functioning at the non- or partially ambulant Gross Motor Function Classification System levels [GMFCS III to V]).⁸ Although their MSK systems usually appear to be radiologically normal at birth, children with such severe neurological impairments are at increased risk of developing MSK complications, including hip displacement, muscle contractures, and scoliosis,⁹ which often present before the age of 5 years.¹⁰ Figure 1 shows the extent of MSK …