A cautious approach is urged in relation to new research suggesting that 70% of therapies for people with cerebral palsy are of uncertain benefit.
By Paul Rumley
New literature  has been published which reviewed the results of treatments provided for children with cerebral palsy in 166 articles – this was essentially a systematic review of systematic reviews. The conclusions were that 70% of the treatments for cerebral palsy had poor or inconclusive evidence about whether or not they were effective (so called “yellow light” therapies).
Some of the well-established treatments which were thought to be questionable included gastrostomy (a feeding tube inserted into the stomach), orthopaedic surgery generally and in particular hand and hip surgery, body suits to help with posture and hydrotherapy.
These surprising findings lead to the question as to how much weight should be attached to this new literature and what implications it has for clinical negligence claims for people with cerebral palsy.
In reviewing the evidence for the outcome for various treatments and therapies the authors used an evidence alert traffic light system ranking treatments as green, i.e. effective, yellow are of questionable effectiveness and red light, i.e. do not do.
One of the most surprising conclusions is that hydrotherapy is a “yellow light” therapy on the basis that it had “lower quality supporting evidence” with the quality of that evidence being “low” and therefore the strength of the recommendation of it as a therapy being “weak+”. This is both surprising and concerning, because specialists in hydrotherapy have been arguing about the benefits of it for years, and lawyers have been arguing equally for years as to whether or not an expensive hydrotherapy pool should form part of the compensation awarded to a child who suffers from cerebral palsy as a result of medical negligence around the time of their birth.
If you speak to specialists in the field of hydrotherapy, they readily admit that no reported studies into the benefits of hydrotherapy have been carried out. However, they argue that it is in essence a matter of common sense that for someone who lacks movement, taking away the effects of gravity, which you do for a patient in water, thereby allowing them to move more freely has to be beneficial. In addition, there are the unmeasurable psychological benefits of allowing a child with cerebral palsy whose world is so severely restricted, the “joy” of free movement for periods of time.
Specialists in the field of hydrotherapy have been promising to publish some strong evidence in this field and it is now clearly long overdue.
We are very often involved in medical negligence claims on behalf of children with cerebral palsy, where the costs of many of the therapies which have been put into the yellow traffic light category in this new literature are concerned – most notably hydrotherapy. Specialists in the use of hydrotherapy are absolutely convinced of its merits, and it seems unreasonable for Defendants who have caused such devastating injuries to argue against the benefits of hydrotherapy and therefore the need for hydrotherapy pools at home. For a child denied the basic freedom of movement which the rest of us take for granted, as a result of cerebral palsy, to regain some measure of that with hydrotherapy has to, if only on a common sense basis, have a significant benefit for that child.
It is also important to bear in mind this view is simply a paper based review of what literature currently exists. For those areas of therapy – such as hydrotherapy – for which literature does not yet exist then the uncertain classification of the effectiveness of therapy by giving it a yellow light grading is in itself of questionable weight.
It is to be hoped that some worthwhile literature in such areas as hydrotherapy are published soon to counter the arguments which are bound to follow this new literature. We are certainly bound to be involved in claims where we will be challenging the weight to be applied to it.
If you have a child who may have suffered cerebral palsy or any other injury as a result of poor medical treatment then please contact the Clinical Negligence Team who can guide you through the options available to you. A systematic Review of Interventions for Children with Cerebral Palsy: State of the Evidence by Novak et al (Developmental Medicine and Child Neurology 2013 pages 1-26).