title: Evaluation of stress and pain in young children with cerebral palsy during early developmental intervention programs: a descriptive study.
abstract: OBJECTIVE
  The aim of this study was to use the Face, Legs, Activity, Cry, Consolability Scale; salivary cortisol levels; and withdrawal reflex thresholds to assess pain, stress, and pain sensitivity in young children with cerebral palsy during early developmental intervention programs.
  
  
  METHODS
  A total of 40 children with cerebral palsy (age range, 1-4 yrs) participated in the early intervention programs, which included neurodevelopmental treatment, neuromuscular electrical stimulation, occupational therapy, head acupuncture, and Chinese traditional manipulation five times per week for 3 wks. The Face, Legs, Activity, Cry, Consolability Scale was applied during the course of each treatment, and salivary cortisol samples were obtained from each child 10 mins before and 10 mins after each treatment. Withdrawal reflex thresholds were assessed via mechanical stimulation of the foot with von Frey hairs.
  
  
  RESULTS
  All treatment programs caused some degree of pain. In descending order, the extents of the pain caused by each treatment were head acupuncture, neurodevelopmental treatment, neuromuscular electrical stimulation, Chinese traditional manipulation, and occupational therapy. There were statistically significant increases in salivary cortisol levels after the head acupuncture (P < 0.001), neurodevelopmental treatment (P < 0.001), neuromuscular electrical stimulation (P < 0.001), and Chinese traditional manipulation (P < 0.001) treatments. No significant changes were found in the withdrawal reflex thresholds during the study (P > 0.05).
  
  
  CONCLUSIONS
  The results of this study demonstrate that early developmental intervention programs cause pain and stress in young children with cerebral palsy.
authors.affiliation: From the Rehabilitation Department (XZ, SD, HL) and Department of Healthcare (MC, XL), Nanjing Children's Hospital Affiliated to Nanjing Medical University, Nanjing, China.
authors.forename: Xiaoke
authors.initials: X
authors.lastname: Zhao
authors.forename: Mengying
authors.initials: M
authors.lastname: Chen
authors.forename: Senjie
authors.initials: S
authors.lastname: Du
authors.forename: Hongying
authors.initials: H
authors.lastname: Li
authors.forename: Xiaonan
authors.initials: X
authors.lastname: Li
mesh_terms: D015670:Acupuncture Therapy; D002547:Cerebral Palsy / Q000523:psychology* / Q000534:rehabilitation*; D002675:Child, Preschool; D000529:Complementary Therapies; D061345:Early Medical Intervention; D004599:Electric Stimulation Therapy; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000032:analysis*; D007223:Infant; D008297:Male; D026301:Manipulation, Osteopathic; D009788:Occupational Therapy; D010146:Pain / Q000453:epidemiology*; D012463:Saliva / Q000737:chemistry*; D013315:Stress, Psychological / Q000453:epidemiology*
chemical_list: D006854:Hydrocortisone