Complementary and Alternative Medicine (CAM)

Complementary 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 patients and families use complementary and alternative therapy.

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.

Questions patients and families should ask when evaluating CAM:

  • Is there any research evidence that the treatment is useful for individuals with the same condition as mine? Keep in mind that not all “research” is true evidence of efficacy. For example, a simple case report or series of cases reported carries only a low level of evidence as it provides only for showing a possible association. Whereas a randomized clinical trial is considered a very high level of evidence of efficacy. Your clinician may be able to help you understand the level of evidence of any research that exists.
  • Is the treatment safe? What side effects have been seen or might be seen including impacts on health, behavior and family?
  • Are there other treatments that are safer or more effective that I should consider first?
  • How much does the treatment cost and is it covered by my insurance?
  • Are there RED FLAGS? For example, does the treatment claim to cure a wide variety of conditions yet have no side effects? Is someone making a very large profit from this 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?

Talk these questions over with your health care provider. It is okay to schedule an appointment just to talk about the therapy you are considering. It is important for you to let your healthcare provider know what treatment you are considering in advance of the appointment so they can review the latest information available. 

Evidence Based Medicine

Clinicians including doctors, therapists, dietitians, dentists and other providers strive to rely most 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), because they are being used in situations that do not allow for research to evaluate the treatment adequately (e.g. rare conditions), or because, despite preliminary evidence of the treatments usefulness, definitive research has not been completed (often due to inadequate funding). 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 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 although this is evolving. Integrative medicine or integrative health is the combination of practices and methods of alternative and evidence based medicine. 

There is very little knowledge about CAM therapies, especially in children with disabilities. They are used by CAM practitioners 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 hippo therapy 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, and hyperbaric oxygen therapy. The important issues are: What evidence exists that supports the claims of CAM practitioners? Are any beneficial effects long lasting? Is it harmful?

Parents and other caregivers can turn to a variety of sources for information about CAM therapies. A common but not necessarily optimal 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, the Down Syndrome Foundation).

What are some examples of Alternative medicine?

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

Some of these treatments have evolved data for their role in treating certain specific conditions in which case their role in the management of that specific condition may be considered evidence based as opposed to complementary.  For example, chiropractic’s for low back pain in adults. Some therapies are currently being investigated in well-designed clinical trials (e.g. stem cell therapy for CP due to birth injury). Other therapies continue to have limited evaluation.

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