The goal for the use of adaptive equipment is to improve positioning either in the supine or sitting position, or to improve the level of function in self-care skills, including in the home, school, or community. These devices include, but are not limited to, seating or support systems, mobility devices, augmentative communication devices, computer or computer aids, and environmental control devices. A team, including physicians and therapists to assess physical capabilities, as well as to develop and refine appropriate goals, is essential to address and optimize adaptive equipment needs for children with CP.
COMPLEMENTARY AND ALTERNATIVE THERAPIES
The use of complementary and alternative medicine (CAM) in CP is not uncommon. CAM has been defined by The American Academy of Pediatrics as "strategies that have not met the standards of clinical effectiveness, either through randomized controlled clinical trials or through the consensus of the biomedical community" (237). It is not surprising that caregivers would be attracted to therapies that promise significant functional improvement when traditional medicine may appear to have little to offer. CAM is more commonly used in children with chronic diseases, such as CP, despite lack of substantiating evidence (238). CAM is often used in addition to orthodox medicine, but often its use is not discussed with the child's treating physician secondary to a feared negative response (238). Several studies have documented increased use of CAM in children placed in higher GMFCS categories (239,240). One study found that 56% of families surveyed had utilized at least one CAM therapy for their child with CP (239). The most commonly utilized therapies were massage therapy (25%) and aquatherapy (25%). The most significant predictors of use were the child's age (younger), lack of independent mobility, and parental use of CAM (239). Other CAM therapies utilized by children with CP include conductive education (CE), patterning, hyperbaric oxygen therapy (HBOT), Adeli suit therapy (AST), acupuncture, cranial osteopathy, and many others.
Hyperbaric Oxygen Therapy
Proponents of HBOT propose that "dormant areas" can be found surrounding injured areas in the brains of children with CP and that high levels of oxygen in the brain reactivate, or "wake up," the cells of this dormant area (241). Delivery of hyperbaric oxygen typically consists of treatments with pressures of 1.5 to 1.75 atmospheres for 1 hour per session, sometimes as often as five to six times per week, for up to 40 treatment sessions in a phase of treatment. A blind, randomized, controlled clinical trial of 111 children with CP compared treatment with hyperbaric oxygen at 1.75 atmospheres with a control group that received air at a pressure of 1.3 atmospheres (242). Both groups demonstrated significant functional improvements, but no differences were found between the groups. While some authors have argued that this demonstrates the value of elevated oxygen, even at minimal levels (243), others argue that the effect demonstrates a "powerful clinical trials effect" (244), with the effect primarily due to highly motivated parents spending many hours with the children in an intensive setting, knowing that developmental outcomes would be evaluated (241). A systematic review of the evidence revealed that there is inadequate evidence to establish a significant benefit of HBOT or for identifying potential adverse effects of HBOT in children with CP (245) and that adverse events are possible, and it is therefore not recommended (98).