"It has to be painful to be effective": children with cerebral palsy and physical therapy.
Dr Hélène SAUDREAU BOTHORELa, Dr Laetitia HOUXb, Dr Philippe LE MOINEb, Mrs Claire MORVANb, Dr Mathilde CREUSATa, Dr Véronique TSIMBAa, Prof Olivier REMY-NERISb, Prof Jean-Yves LE RESTEb, Dr Sylvain BROCHARDb
a Centre Mutualiste de Rééducation et Réadaptation Fonctionnelle de Kerpape, b CHU Brest
Introduction : Cerebral palsy (CP), the most common cause of motor disability in childhood, is responsible for activity limitations and pain that occurs during physical therapy. The purpose of this study was to analyze the report of children with cerebral palsy on the physical therapy activities, to identify painful gestures and locations and to explore the management of pain developed by the children and therapists.
Materials and Methods : 18 children with PC with a pain numerical scale > 2 (mean 13.1 years, 10F / 8H) were recorded during "Focus Group" interviews. The questions followed a logical progression of the interview grid. The themes were enriched gradually until data saturation.
Results : Three themes emerged from the interviews:
1 / Experiences and emotional impact: notion of pleasure, physiotherapy clinical benefit but also concept of stress and boredom.
2 / Pain: difficult experiences, guarantee of effectiveness, clinical marker. Stretching exercises were mostly reported. The relationship with the therapist had a great impact.
3 / Pain management: development of adapting techniques to pain by children (from distraction to drugs), adaptation or not by the therapist.
Discussion: This study confirms the reality of induced pain during physiotherapy in a sample of young children and young adults. The pain seems to be induced especially during stretching. Conceptually, the pain was associated with the efficacy and clinical improvement. The relationship with the therapist impacted the “feeling” of pain. New way of stretching and improvement in communication between therapists and patients may help in reducing the care-related pain.
 Jensen MP, Moore MR, Bockow TB, Ehde DM, Engel JM. Psychosocial factors and adjustment to chronic pain in persons with physical disabilities: a systematic review. Arch Phys Med Rehabil. 2011.
Keywords : Cerebral palsy, Experience, Pain, Physical therapy