Abstract
We would like to make members and others aware of a report of an International Society for Prosthetics and Orthotics (ISPO) Cerebral Palsy Consensus Conference, titled Recent Developments in Healthcare for Cerebral Palsy: Implications and Opportunities for Orthotics. 1
The history to this publication is that, in 1994, ISPO convened a consensus conference on the lower limb orthotic management of cerebral palsy (CP). That conference considered the evidence for the use of lower limb orthoses in the physical management of children with CP from the multidisciplinary perspective which underlies the ethos of the society. The report of the 1994 conference, published the following year, became the society's most successful publication. The report was used by ISPO as the basis for a series of nine instructional courses held around the world to disseminate the key treatment principles and clinical practices that were recommended.
Clearly there have been many developments in the understanding and management of CP in recent years. In 2007, the Executive Board of ISPO, mindful of its responsibility to ensure that orthotic practice keeps apace with advances in healthcare, resolved to convene a follow-up to the previous conference. This time the aim was to consider relevant recent research and contemporary thinking in the healthcare of people with CP, and to identify the implications for orthotic research and clinical practice. The scope of the conference was expanded to include consideration of the evidence regarding the management of the spine, hips, and upper limbs.
An international, multidisciplinary group of 24 healthcare professionals and research scientists, all of whom are recognized experts in their subject area, were invited to take part in the conference held in Wolfson College, Oxford, UK, in September 2008. Twelve of the participants presented oral and written review papers; their topics included a global health perspective, definition and classification of CP, classification of gait, physiotherapy, occupational therapy, and medical, surgical, and orthotic management. The reviewers of specific treatments were asked to synthesize the best available evidence and, where possible, to grade their recommendations using the Oxford Centre for Evidence-based Medicine Levels of Evidence.
Ten participants were nominated to each lead a plenary discussion session that followed the presentation of review papers. Participants were then separated into three smaller groups with the composition varying over the course of the conference. The small groups were used to explore gaps in the evidence and consider areas of controversy. In order to structure the discussions, the organizers and chairperson of each session devised a number of questions for the groups to address. Further plenary sessions were then held to hear the reports from each group and to synthesize their recommendations. The whole conference, which lasted for three and a half days, was extremely rich in content and involved a great deal of hard work for everyone involved due to the huge amount of material which was covered.
Following the conference, a first draft of conclusions and recommendations resulting from the small group reports was formulated by the organizers. This was first submitted to a previously agreed representative nominal group of the participants for comments. After modification to take account of their suggestions, this document was supplemented by the addition of the principal conclusions contained in the reviews. The resulting composite ‘Conclusions and Recommendations’ from the conference were then submitted to all participants for final comment and approval.
There are overarching themes that highlight the need to increase awareness of the World Health Organization's International Classification of Functioning, Disability and Health (ICF) 2 and key issues in the organization and delivery of efficient health services. Other recommendations include making use of the Gross Motor Function Classification System 3 and similar tools for classifying and communicating children's abilities. The advantages and limitations of current classifications of gait for people with CP are well critiqued. Evidence-based recommendations for clinical practice, and topics requiring further research, are highlighted for physiotherapy, occupational therapy, and medical, orthopaedic and orthotic management.
The presentations and plenary discussions were all video and/or audio recorded by our industrious media team. The report and recordings have been collated and made available by ISPO on the Internet, free of charge, through the society's website. 1 ISPO intend to use the report as an educational resource for further instructional courses and disseminate the information as broadly as possible with the aim of improving the healthcare of people with CP worldwide.
The organizers would like to thank all the participants for their sustained efforts and commitment to their tasks, and their contributions to the report.
Note: A similar version of this manuscript has been published as a Conference Report in the journal Developmental Medicine & Child Neurology 51(9):689.