The mother of a 5-year-old boy with

athetoid cerebral palsy complains of

difficulties putting his Lycra suit on

each day. She is keen to know if it actually

helps improve his function and

movement.

STRUCTURED CLINICAL QUESTION

In children with cerebral palsy (population),

do Lycra garments (intervention)

improve function and posture

(outcome)?

SEARCH STRATEGY

The search was performed in October

2009

Coghill, J. E.

Simkiss, Douglas E.

English

Warwick Research Archives Portal Repository

 University of Warwick institutional repository: http://go.warwick.ac.uk/wrap  This paper is made available online in accordance with publisher policies. Please scroll down to view the document itself. Please refer to the repository record for this item and our policy information available from the repository home page for further information.  To see the final version of this paper please visit the publisher’s website. Access to the published version may require a subscription. Author(s):  J E Coghill and D E Simkiss Article Title:  Question 1 Do lycra garments improve function and movement in children with cerebral palsy? Year of publication: 2010 Link to published article: http://dx.doi.org/10.1136/adc.2009.178624 Publisher statement:  None     doi: 10.1136/adc.2009.178624 2010 95: 393-395Arch Dis Child J E Coghill and D E Simkiss and movement in children with cerebral palsy?Question 1 Do lycra garments improve function http://adc.bmj.com/content/95/5/393.1.full.htmlUpdated information and services can be found at: These include:References http://adc.bmj.com/content/95/5/393.1.full.html#ref-list-1This article cites 8 articlesserviceEmail alertingbox at the top right corner of the online article.Receive free email alerts when new articles cite this article. Sign up in theNotes http://adc.bmj.com/cgi/reprintformTo order reprints of this article go to:  http://adc.bmj.com/subscriptions go to: Archives of Disease in ChildhoodTo subscribe to  group.bmj.com on September 8, 2010 - Published by adc.bmj.comDownloaded from ArchimedesArch Dis Child May 2010 Vol 95 No 5 393QUESTION 1DO LYCRA GARMENTS IMPROVE FUNCTION AND MOVEMENT IN CHILDREN WITH CEREBRAL PALSY?The mother of a 5-year-old boy with athetoid cerebral palsy complains of difﬁ culties putting his Lycra suit on each day. She is keen to know if it actu-ally helps improve his function and movement.STRUCTURED CLINICAL QUESTIONIn children with cerebral palsy (pop-ulation), do Lycra garments (interven-tion) improve function and posture (outcome)?SEARCH STRATEGYThe search was performed in October 2009.Primary sourcesMedline, EMBASE and CINAHL were searched with the terms ‘cerebral palsy’ (as keyword and exploded MESH term) AND ‘Lycra’ (as keyword and exploded MESH term ‘splints’ and ‘clothing’ from search tree).Limits were human, English language, age (0–18 years). Only papers from 1990 onwards were searched as Lycra splints/suits were only developed in early 1990s.Secondary sourcesThe Cochrane Library yielded no rele-vant results.SEARCH OUTCOMENo systematic reviews were found; 66 papers were identiﬁ ed, but only eight were relevant to the research question. One paper was a descriptive study, cross-over and recipient trial, and one was a review article including two case stud-ies. Five papers were case series and there was one case study.COMMENTARYLycra splints and suits are made-to-measure garments designed for an indi-vidual child’s needs. It is impossible to generalise about suitability and speciﬁ c designs of garments making individual assessment and prescription essential. The extent to which the garment covers the child depends on what is required and varies from a simple glove for the hand and wrist to a full body suit. The beneﬁ ts of Lycra include it being ﬂ exible, breathable and non-invasive. Garments Clinical bottom line▶  Lycra garments are useful as they provide the child with improved proximal stability which enhances functional abilities (grade C).▶  Lycra garments are expensive and can cause problems with a child’s comfort and toileting (grade C).17_archdischild_178624, ac186288, ac186411, ac186775.indd   393 4/21/2010   4:08:25 PM group.bmj.com on September 8, 2010 - Published by adc.bmj.comDownloaded from ArchimedesArch Dis Child May 2010 Vol 95 No 5394Table 1 Do Lycra garments improve function and movement in children with cerebral palsy?Citation Patient group Study type Outcome Key result CommentsBlair et al1 24 Patients (15 months to 14 years) with cerebral palsy (7 spasticity, 5 athetosis, 7 dystonia, 4 ataxia, 1  hypotonia) and 8 controls (matched by age and ability).8 patients given Lycra suits, for 8 h/day (4 weeks’ wear, 3 weeks without, 6 weeks’ wear)Descriptive study, crossover trial and recipient-control study (level 2b)1. Care giver questionnaire.2. Video recordings.3. Spirometry.4. Grip strength1. Improved postural stability for group (p=0.035) and  individually (p=0.003) with Lycra suit from video.2. No signifi cant  difference in muscle strength/respiratory capacityLack of validated assessment tools.Unclear randomisation.Observers not  adequately blinded for video assessmentEdmondson et al2 15 Patients (2–12 years) with cerebral palsy (2 hypotonia, 6 spastic/athetoid, 4 spastic/diplegia, 2 spastic quadriplegia, 1 hemiplegia with ataxia) wearing Lycra suits for 6 h/day for 12 monthsCase series (level 4) 1. Improvement in gross/fi ne motor skills1. Wearing Lycra suit improved function and posture.2. Useful aid to other therapiesNo standardised  assessment tool usedNicholson et al3 12 Patients (2–17 years old) with cerebral palsy (7 spasticity, 4 athetoid, 1 ataxic). Wore individually tailored Lycra garments for 6 h/day for 6 weeks plus usual therapyCase series (level 4) 1. Paediatric Evaluation of Disability Inventory (PEDI).2. Parent/carer questionnaire.3. Motion analysis of 5 selected children1. 11 Children had positive change in one or more PEDI domain.2. Statistically  signifi cant improvement in group score for self-help domain p<0.01.3. Less signifi cant improvement noted with care giver scores (p<0.05).4. Practical diffi culties of garments highlighted in questionnaire. Only 1 from the 12 wanted second garmentSmall sample size with no control group.Only focused on upper limb.Heterogeneous group of children with cerebral palsy. 7Families reported their child did not like the garmentKnox4 8 Patients (3–13 years) with cerebral palsy (2 spastic quadriplegia, 2 spastic diplegia, 2 choreoathetosis, 2 dystonic quadriplegia subgroups).Wearing Lycra garment for more than 4 h for 4 weeksCase series (level 4) 1. Gross Motor Function Measure (GMFM).2. Quality of Upper Extremity Skills Test (QUEST).3. Parent/child questionnaireMeasured at baseline and 4 weeks1. 4 Children withdrew owing to non-compliance (n=3) or wearing spinal orthosis (n=1).2. Children who continued to wear garments showed benefi ts on standardised tests and questionnaireUnable to carry out sta-tistical analysis owing to small sample size.Lack of control group.Potential assessor bias as author was main assessor in every case except one.Lack of patient appropri-ate upper limb assess-ment toolRennie et al5 8 Patients (5–11 years) (7 with cerebral palsy, 1 with Duchenne’s muscular dystrophy).Predominant impairment: 5 spasticity, 1 athetosis, 1 hypotonia, 1 weakness.Wearing whole-body Lycra garments for at least 6 h/day for 6 weeksCase series (level 4) 1. 3D Gait analysis.2. PEDI.3. Parental reports (lower limb)Measured at baseline and 6 weeks1. 5/8 Children showed improved gait pattern.2. No statistically signifi cant improvement in PEDI scores.3. 7/8 Parents would not use Lycra garment again because of practicalitiesSmall sample size.Only lower limb assessed.Heterogeneous sample groupCorn et al6 4 Patients (8–16 years) with cerebral palsy (1 ataxic cerebral palsy, 3 spastic quadriplegia).2 were new to wearing splints and 2 had worn splint for more than 12 months.Lycra splints for upper limb worn for up to 6.5 h/dayCase series (level 4) 1. Melbourne Assessment (upper limb).Assessed at baseline and intervention phase twice weekly.Data collection period ranged from 14 to 17 weeks1. No change in quality of unilateral upper limb movement.2. 1 Patient had a decrease in movement with long-term useWithin-patient trends were analysed. Study lacked large homoge-neous group of subjects. Patients were required to participate in many assessments to ensure validityAttard and Rithalia7 2 Patients (6 and 9 years) with cerebral palsy (spastic, athetoid quadriplegia and hemiplegia).Review of Lycra body suit and gloveLiterature review.Case study (level 4)1. Patient/carer attitudes No validated assessments used.Small patient numbersHylton and Allen8 3 Patients (10 months to 12 years) with neuromotor defi cits (spastic diplegia, quadriplegia and extensor posturing/poor postural control).Use of Lycra compression bracingCase study (level 4) 1. Patient/carer attitudes.2. Observational discussion1. Reported improved walking, balance, propri-oceptive awareness and ability to complete complex skillsNo validated assessments used.Small patient numbers17_archdischild_178624, ac186288, ac186411, ac186775.indd   394 4/21/2010   4:08:26 PM group.bmj.com on September 8, 2010 - Published by adc.bmj.comDownloaded from ArchimedesArch Dis Child May 2010 Vol 95 No 5 395can be reinforced if greater pressure is needed for particular muscles.7No systematic reviews or randomised controlled trials of Lycra garments have been conducted. Most of the published papers in this ﬁ eld are case series with small patient numbers. The available studies suggest wearing Lycra garments helps to improve proximal stability and function in some children with cerebral palsy, but evidence is limited. Many of the studies include children with differ-ent types of cerebral palsy and do not use objective outcome measures such as Gross Motor Function Measure.9It is important to consider the practical difﬁ culties of wearing Lycra garments. They are tight ﬁ tting and difﬁ cult to get on and off. Children often complain of discomfort and they cause problems when bathing and toileting. Many of these problems could be overcome by improved design and considering toilet-ing needs carefully.The issue of cost cannot be ignored, with some garments costing over £1000 if extra boning is required and these gar-ments need to be replaced as children grow. It is vital to consider the individ-ual patient and carer attitudes to wearing Lycra splints and suits. Unless they can be made more functionally attractive they will only be used for children for whom the improvements in function outweigh the disadvantages of wearing the gar-ment. At present, evidence suggests that this would include children with atheto-sis, ataxia and poor truncal tone.Involvement of families in research and development could, via focus groups, address some of the functional issues of Lycra suits. With families, appropriate outcome measures for measuring suc-cess with Lycra suits could be devel-oped. Randomised controlled trials with more homogeneous patient groups and adequate power to identify these out-comes are required. Cost-effectiveness also needs to be addressed. More research is needed before we can implement an evidence-based approach to using Lycra garments in the management of children with cerebral palsy.J E Coghill, SpR Neonatology, Addenbrooke’s Hospital, Cambridge, UKD E Simkiss, Health Sciences Research Institute, Warwick Medical School, University of Warwick, Coventry, UKCorrespondence to Dr J E Coghill, SpR Neonatology, Addenbrooke’s Hospital, Hills Road, Cambridge CB2 0QQ, UK; joanna.coghill@gmail.comAccepted 14 February 2010Competing interests None.Provenance and peer review Not commissioned; not externally peer reviewed.Arch Dis Child 2010;95:393–395.doi:10.1136/adc.2009.178624REFERENCES 1. Blair E, Ballantyne J, Horsman S, et al. A study of a dynamic proximal stability splint in the management of children with cerebral palsy. Dev Med Child Neurol 1995;37:544–54. 2. Edmondson J, Fisher K, Hanson C. How effective are lycra suits in the management of children with cerebral palsy? J Assoc Paediatr Chart Physiotherapists 1999;90:49–57. 3. Nicholson JH, Morton RE, Attfi eld S, et al. Assessment of upper-limb function and movement in children with cerebral palsy wearing lycra garments. Dev Med Child Neurol 2001;43:384–91. 4. Knox V. The use of Lycra garments in children with cerebral palsy: a report of a descriptive clinical trial. Br J Occup Ther 2003;66:71–7. 5. Rennie DJ, Attfi eld SF, Morton RE, et al. An evaluation of lycra garments in the lower limb using 3-D gait analysis and functional assessment (PEDI). Gait Posture 2000;12:1–6. 6. Corn K, Imms C, Timewell G, et al. Impact of Second Skin Lycra Splinting on the Quality of Upper Limb Movement in Children. Br J OccupTher 2003;66:464–72. 7. Attard J, Rithalia S. A review of the use of Lycra pressure orthoses for children with cerebral palsy. Int J Ther Rehabil 2004;11:120–6. 8. Hylton N, Allen C. The development and use of SPIO Lycra compression bracing in children with neuromotor defi cits. Pediatr Rehabil 1997;1:109–16. 9. Neville B, Albright AL. The management of spasticity associated with the cerebral palsies in children and adolescents. New Jersey, USA: Churchill Communications, 2000.17_archdischild_178624, ac186288, ac186411, ac186775.indd   395 4/21/2010   4:08:26 PM group.bmj.com on September 8, 2010 - Published by adc.bmj.comDownloaded from 

A review of the use of Lycra pressure orthoses for children with cerebral palsy.

A study of a dynamic proximal stability splint in the management of children with cerebral palsy. Dev Med Child Neurol

An evaluation of lycra garments in the lower limb using 3-D gait analysis and functional assessment (PEDI). Gait Posture

Assessment of upper-limb function and movement in children with cerebral palsy wearing lycra garments. Dev Med Child Neurol

How effective are lycra suits in the management of children with cerebral palsy? J Assoc Paediatr Chart Physiotherapists

The development and use of SPIO Lycra compression bracing in children with neuromotor deﬁ cits. Pediatr Rehabil

The management of spasticity associated with the cerebral palsies in children and adolescents.

The use of Lycra garments in children with cerebral palsy: a report of a descriptive clinical trial.

Do lycra garments improve function and movement in children with cerebral palsy?

http://wrap.warwick.ac.uk/3365/1/WRAP_Simkiss_Lycra_Garments_cerebral_palsy.pdf

Do lycra garments improve function and movement in children with cerebral palsy?

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