title: What is the evidence for managing tone in young children with, or at risk of developing, cerebral palsy: a systematic review.
abstract: To conduct a systematic review of the evidence for the management of tone in infants 0-24 months of age, with or at risk of developing cerebral palsy.
  
  
  
  This review was conducted and reported following the Preferred Reporting Items for Systematic Reviews and Meta-analyses Statement. The Cochrane Central Register of Controlled Trials, Embase, MEDLINE, CINAHL Plus and PsycINFO databases were systematically searched for relevant articles. Inclusion criteria were: children aged 0-24 months, identified as at risk of, or having cerebral palsy; ≥25% of participants ≤24 months, and included a standardized assessment of tone. Only peer reviewed journal articles were considered. Eligible studies were coded using the Oxford Levels of Evidence. Methodological quality was assessed using the PEDro scale for randomized controlled trials and the checklist for assessing the quality of quantitative studies of Kmet, Cook and Lee for non-randomized control trials.
  
  
  
  A total of 4838 studies were identified. After removing duplicates and unrelated studies, a total of 56 full text studies were reviewed. A total of five studies met inclusion criteria, two of which were RCTs, two pre-/post-test designs and one retrospective case audit. Interventions included BoNT-A, Oral Baclofen, Neurofacilitation of Developmental Reaction and Neurodevelopmental Therapy. The quality of evidence ranged from limited to moderate.
  
  
  
  The management of tone in infants and young children is not well described, with a dearth of high-level evidence to support intervention in the 0-24 month age-range. This is in contrast to a recent review completed by Novak et al. (2013) who report high levels of evidence of interventions for children with cerebral palsy, over 2 years of age. Implications for Rehabilitation High level of evidence to support clinical decision making for the management of tone in young children 0-24 months is not available. The lack of available evidence in the management of tone of young children underpins service delivery and intervention and impacts on patient outcomes. In the absence of clear research evidence, the systematic application of sensitive outcome measures is required to confirm treatment effects and generate new evidence. Hypertonia should not be managed in isolation. Consideration needs to be given to all components of the ICF-CY.
authors.affiliation: a Department of Paediatric Rehabilitation , Princess Margaret Hospital for Children , Perth , Western Australia , Australia.|b School of Paediatrics and Child Health , The University of Western Australia , Perth , Western Australia , Australia.
authors.forename: Roslyn
authors.initials: R
authors.lastname: Ward
authors.affiliation: a Department of Paediatric Rehabilitation , Princess Margaret Hospital for Children , Perth , Western Australia , Australia.|c School of Sport, Science, Exercise and Health , the University of Western Australia , Perth , Western Australia , Australia.
authors.forename: Jess E
authors.initials: JE
authors.lastname: Reynolds
authors.affiliation: a Department of Paediatric Rehabilitation , Princess Margaret Hospital for Children , Perth , Western Australia , Australia.|d Telethon Kids Institute , Perth , Western Australia , Australia.|e Department of Physiotherapy , Princess Margaret Hospital for Children , Perth , Western Australia , Australia.|f Department of Clinical Research, Princess Margaret Hospital for Children, Perth, Western Australia, Australia.
authors.forename: Natasha
authors.initials: N
authors.lastname: Bear
authors.affiliation: a Department of Paediatric Rehabilitation , Princess Margaret Hospital for Children , Perth , Western Australia , Australia.|g School of Occupational Therapy and Social Work , Curtin University , Western Australia , Australia.
authors.forename: Catherine
authors.initials: C
authors.lastname: Elliott
authors.affiliation: a Department of Paediatric Rehabilitation , Princess Margaret Hospital for Children , Perth , Western Australia , Australia.|b School of Paediatrics and Child Health , The University of Western Australia , Perth , Western Australia , Australia.
authors.forename: Jane
authors.initials: J
authors.lastname: Valentine
mesh_terms: D000367:Age Factors; D002547:Cerebral Palsy / Q000503:physiopathology / Q000628:therapy*; D002675:Child, Preschool; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D009129:Muscle Tonus
keywords: Early intervention; hypertonia; systematic review