Complementary and Alternative Medicine (CAM)

^{Written by: The My Child Without Limits Medical Advisory Committee and last reviewed May 25, 2009}

Complimentary and alternative medicine (CAM) is a group of medical and health care systems, practices, and products that are not generally considered to be part of conventional medicine. While scientific evidence exists regarding some CAM therapies, for most there are key questions that are yet to be answered through well-designed scientific studies -- questions such as whether these therapies are safe and whether they work for the purposes for which they are used. CAM can include herbs and dietary supplements, massage, acupuncture, chiropractic care, naturopathy, homeopathy, etc. A large portion of families with children with developmental disabilities turn to complementary and alternative therapies to address some aspect of the disabling condition.

Unfortunately, many families that choose complementary and alternative treatments for their children do not disclose this information to their health or service providers. This makes the providers' job more difficult and does not allow the provider to assist with decisions around the use of these treatments. Good health care providers should be knowledgeable and open in their discussions with families about these treatments to ensure trust and coordination of their services. It is important that families and providers have a useful guide for making decisions about using these therapies to make informed decisions and engage in an ongoing open dialogue about the therapies.

Questions parents should ask when evaluating CAM:

• Is there evidence that the treatment is useful for children with the same condition as mine?
• Is the treatment safe?
• Does the treatment claim to cure a wide variety of conditions?
• How much does the treatment cost and is it covered by my insurance?
• What does my health care provider know about this treatment?
• Have a conversation with your health care provider before using the treatment
• Do reliable sources and solid evidence support the use of this treatment or therapy? Or are the reported benefits coming from commercially driven reports or emotionally based personal endorsements?

Evidence based medicine

Doctors and other clinicians (e.g. physical therapists) rely on diagnostic and therapeutic procedures that have been evaluated in research studies and found to be useful and reliable. There are some laboratory tests and clinical procedures that have not been tested in a research setting but are accepted as part of contemporary medicine because they have been demonstrated to be useful over many years of careful observation (e.g. surgical appendectomy for an inflamed appendix). However, for the most part, contemporary medicine is based upon evidence based analyses and is accepted in western societies as the basis for acceptable clinical care. They are the core of the acceptable procedures used by licensed health care and service providers and are usually included in the reimbursement payments of government and private insurance plans.

Complementary and Alternative Medicine (CAM):

There are a variety of clinical procedures that are that are derived from other philosophical approaches to body function and dysfunction. When these procedures are used in conjunction with evidence based medicine they are called complementary medicine; when used instead of evidence based medicine, they are called alternative medicine. CAM procedures are generally not included in the reimbursement payments of many insurance plans.

There is very little knowledge about CAM therapies, especially in children with disabilities. They are used by CAM practioners for health promotion, disease prevention, diagnostic testing, and disease and disability therapy. CAM therapies are used for children in a wide spectrum of developmental disabilities such as intellectual disability, cerebral palsy, autism, learning disabilities, ADHD and epilepsy. A number of innovative procedures are presently being evaluated in carefully designed studies including robotic therapy for improved upper and lower limb mobility and hippotherapy for improved musculoskeletal coordination. However, most CAM therapies have rarely been scientifically studied and so their usefulness and effectiveness is not well understood. Some could be helpful, some harmful and studies are underway to test some of these interventions.

The National Center for Complementary and Alternative Medicine, a division of the government's NIH, is actively involved in fostering CAM research studies. Other Divisions of the NIH are also involved in CAM research studies related to their areas of responsibility: for example, The National Institute of Child Health and Human Development (NICHD) and the National Institute of Neurological Disorders and Stroke (NINDS). Each NIH Institute has a website describing its activities. Several not-for-profit, citizen supported organizations (e.g. the Cerebral Palsy International Research Foundation; the March of Dimes) also support CAM research in their respective areas of interest. Each of these organizations has a website describing their programs.

There are a broad variety of approaches emphasized in CAM therapies. Several address improving the status "of the body as a whole" and "assisting the body to heal itself". An example is nutritional and herbal supplements; other examples are "spirituality" and disrupted "body energy forces". Some CAM therapies are said to address specific dysfunctions; examples of these are massage therapy, cranial manipulation, hyperbaric oxygen therapy. The important issues are: What evidence exists that supports the claims of CAM practioners? Are any beneficial effects long lasting? Does it do harm?

Parents and other caregivers can turn to a variety of sources for information about CAM therapies. The most common source is "word of mouth" -- either from acquaintances or the internet. People have to be very careful in evaluating information from these sources since they are often very biased; in the case of the internet, they can be commercially driven. More balanced views are usually available from your personal physician, the NIH and from not-for-profit organizations in the specific disorder area (e.g. UCP; the Autism Society of America).

What are some examples of Alternative medicine?

• Acupuncture
• Adeli Suit (Neurosuit, Euromed, Intensive PT)
• Conductive Education
• Craniosacral Therapy (CST)
• Feldenkrais
• Hippotherapy (integrating therapy with horseback riding)
• Hyperbaric Oxygen Therapy (HBOT)
• Patterning (Doman-Delecato)
• Stem cell therapy
• Therapeutic Electrical Stimulation (TES)
• Yoga