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This educational activity has been a joint collaboration between Dannmiller and ASiM CE LLC.

Supported by an educational grant from Ipsen Biopharmaceuticals, Inc.

OVERVIEW
Cerebral palsy (CP) is a primary central nervous system disorder that is associated with a number of sensorimotor impairments, including spasticity, dystonia, and rigidity. The relationship between hypertonicity and functional impairment is variable, and it is critical that clinicians are able to recognize and appropriately manage hypertonicity in children with CP. In addition, CP is also associated with many other impairments including skeletal abnormalities, cardiopulmonary dysfunction, reduced exercise capacity, and chronic pain. Treatment of children with CP and management of spasticity requires an individualized approach that is tailored to meet the goals established by the patient, the patient’s family, and the multidisciplinary healthcare team. Physical therapists work closely with patients, family members, and other members of the multidisciplinary care team to identify and achieve treatment goals. Many physical therapy (PT) techniques have been shown to be efficacious or effective for improving motor function and preventing secondary impairments as well as maintaining function. Oral medications and injectable chemodenervation agents can treat spasticity in children with CP, however, of the 4 botulinum toxin (BoNT) agents available for use in the United States (US), only 1 (abobotulinumtoxin A) is currently approved by the US Food and Drug Administration for treating this population. Neurosurgical or orthopedic surgery interventions may also be appropriate for treating this population, and as part of the patient's healthcare team, the surgeon’s role continues on after the procedure to recovery and rehabilitation.

GOAL
The goal of this monograph is to provide physical therapists with an update on the management of children with CP, including physical and occupational therapy, medical, and surgical approaches to improve function and help patients and families to meet their treatment goals. Readers will gain a better understanding of the deficits associated with CP, how various treatment strategies differ in the ways that they modulate underlying spasticity, and the development of individualized CP treatment plans.

INTENDED AUDIENCE
This activity is intended for physical therapists and other healthcare providers who treat children with CP.

LEARNING OBJECTIVES
Upon completion of this activity, the participant should be able to:
  • DESCRIBE the impact of spasticity in children with CP, including its effects on function, growth, and pain.
  • IDENTIFY functional impairments and goals in children with CP, and develop individualized treatment plans.
  • DISCUSS the use of physical therapy, BoNT, other medical therapies, and surgical approaches to the treatment of CP.
ACCREDITATION STATEMENT
This activity has been approved by the Texas Board of Physical Therapy Examiners for 1.50 CCUs for PTs and PTAs.

Release Date:    September 15, 2017

Expiration Date:     September 15, 2018

METHOD OF PARTICIPATION
Participants should first read the objectives and other introductory CME/CE information and then proceed to the educational activity. To receive credit for this activity, please complete the preassessment, read the content of this monograph, complete and pass the postassessment, and complete the activity evaluation. Credit is provided through September 15, 2018. No credit will be given after this date.

In the event you have questions about this activity or are unable to retrieve the certificate, please e-mail cme@dannemiller.com and a certificate will be emailed within 2 weeks.

DISCLAIMER
The content and views presented in this educational activity are those of the authors and do not necessarily reflect those of Dannemiller, ASiM CE LLC, and Ipsen Biopharmaceuticals, Inc. This material is prepared based upon a review of multiple sources of information, but it is not exhaustive of the subject matter. Therefore, healthcare professionals and other individuals should review and consider other publications and materials on the subject.

FEE INFORMATION
There is no fee for participating in this activity.

PARTICIPATING FACULTY
Katharine E. Alter, MD (Course Director)
Pediatric/Adult Physiatrist
Mount Washington Pediatric Hospital
Clinical Assistant Professor, Pediatrics, Physical Medicine Rehabilitation
AT Still University
Mesa, Arizona

Catherine Larsen Coley, PT, DPT, PCS
Pediatric Physical Therapist and Clinical Specialist
Children’s National Health System
Washington DC

Rebecca Leonard, PT, MS, DPT, PCS
Director, Early Intervention Associates, LLC
Rockville, Maryland

Sean A. Tabaie, MD
Pediatric Orthopaedic Surgeon
Children’s National Medical Center
Instructor of Orthopaedic Surgery
George Washington University School of Medicine
Washington DC

Diane L. Damiano, PT, PhD, FAPTA (Reviewer)
Senior Investigator
Chief of Functional and Applied Biomechanics Section
Department of Rehabilitation Medicine
Clinical Center
National Institutes of Health
United States Department of Health and Human Services
Bethesda, Maryland

DISCLOSURES
In accordance with the Accreditation Council for Continuing Medical Education (ACCME), Dannemiller requires that any person who is in a position to control the content of a CME activity must disclose all financial relationships they have with a commercial interest.

The following faculty stated they have no financial relationships with commercial interests: Catherine Larsen Coley, PT, DPT, PCS; Diane L. Damiano, PT, PhD, FAPTA; Rebecca Leonard, PT, MS, DPT, PCS; and Sean A. Tabaie, MD.

The following faculty member has disclosures to be made:
Katharine E. Alter, MD, reports receiving royalties from Demos Medical Publishing and reports serving on the advisory/medical board for the North American Neurotoxin Association.

Bernard Abrams, MD, content reviewer; Jennifer Hodge, Dannemiller project manager; Mark Bowes, PhD, medical writer; Ankita Patel, PharmD, and Jessica Marshall, PhD, ASiM CE, LLC, Medical Directors; and Lisa Mangione, ASiM CE, LLC, Senior Medical Editor have no financial relationships with commercial interests.

To resolve identified/potential conflicts of interest, the educational content was fully reviewed by a member of the Dannemiller Clinical Content Review Committee who has nothing to disclose. The resulting certified activity was found to provide educational content that is current, evidence based and commercially balanced.

OFF-LABEL STATEMENT
Off label statement provided: This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by FDA. The opinions expressed in the educational activity are those of the faculty. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings. Further, attendees/participants should appraise the information presented critically and are encouraged to consult appropriate resources for any product or device mentioned in this program.

TECHNICAL QUESTIONS
Please contact ASiM at 908-253-9001 or webmaster@asimcme.com.

FEE INFORMATION
There is no fee for this educational activity.


TABLE OF CONTENTS
Preassessment Introduction
Katharine E. Alter, MD

Recognizing Hypertonicity and Its Effect on Function, Growth, and Pain in Children with Cerebral Palsy
Rebecca Leonard, PT, MS, DPT, PCS

Individualized Functional Goals and Treatment for Patients with Cerebral Palsy
Katharine E.Alter, MD, and Catherine Larsen Coley, PT, DPT, PCS

Operative Management of Children with Cerebral Palsy
Sean A.Tabaie, MD

Postassessment and Evaluation

Submit a case to review at meeting:


procced to pretest


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