Therapeutic choices in the locomotor management of the child with cerebral palsy---more luck than judgement?

In the past 15 years or so our understanding of many aspects of cerebral palsy has significantly broadened. Traditional concepts regarding aetiology have been radically challenged, and we now acknowledge that “birth asphyxia”, once felt to be implicated in the majority of cases, has a causative role in approximately 10‐15% of cases. 1 Antenatal factors are recognised as having a predominant aetiological role; newer techniques in neuroimaging, progress in exploring homeobox genes, and other developments, have supported this view. 23 Therapeutic nihilism, once prevalent in this field, has fortunately receded with the development of an array of new antiepileptic drugs for children with refractory seizures (seen so often in the child with cerebral palsy), and the enthusiastic application of new feeding techniques has done much to improve the nutritional status and well being of these children. 4