A Systematic Review of Common Physiotherapy Interventions in School-Aged Children with Cerebral Palsy

Abstract

This systematic review focused on the common conventional physiotherapy interventions used with children with cerebral palsy (CP), aged 4 to 18 years, and critically appraised the recent evidence of each of these interventions using the Oxford Centre for Evidence-Based Medicine Levels of Evidence. The search strategy yielded 34 articles after inclusion and exclusion criteria were applied. The investigated physiotherapy interventions included strength and functional training, weight-supported treadmill training (WBSTT), and neurodevelopmental treatment (NDT). A category of treatment dosage was also included. Strength training was the most studied intervention with significant improvements found in the strength of selected muscle groups using dynamometry, with fewer studies showing significant improvement in function. Functional training showed improvements in gross motor function, endurance, and temperospatial measures, such as gait speed and stride length. Nonsignificant trends of improvement on the Gross Motor Function Measure (GMFM) and gait velocity were found for WBSTT by a few studies with low levels of evidence (case series). Of three studies that evaluated NDT, one high-level evidence study, i.e., randomized controlled trial (RCT) found significant improvements on the GMFM. All studies reviewing treatment dosage had high levels of evidence (RCTs), yet found no significant differences for different intensities of treatment. These results indicate that the levels of evidence for physiotherapy interventions, particularly strengthening and to a lesser extent functional training, in school-aged children with CP has improved; however, further high-level evidence is needed for other interventions.

Neurodevelopmental treatment approaches for children with cerebral palsy

“…Novak 2013 performed a systematic review of systematic reviews, which included a wide range of interventions such as medication, physiotherapy, botulism injections and fitness training, among others. A relatively recent review on common, conventional physiotherapy interventions also had methodological limitations, such as the inclusion of observational studies along with randomised trials, and the authors did not assess the quality of the included primary studies or publication bias (Martin 2010). These limitations may have biased their results (NIHR 2014).…”

The challenge of obtaining information necessary for multi-criteria decision analysis implementation: the case of physiotherapy services in Canada

“…Besides the expected direct impact, for example, the direct impact on children with juvenile idiopathic arthritis [30], with cerebral palsy [31], or with cystic fibrosis [32], there are two important benefits of pediatric physiotherapy that emerged: 1) the physiotherapist typically develops a supportive relationship with both the child and his or her family. In this role, the therapist is an essential source of information and education making the physiotherapist a valued link to, and guide through, an often-times overwhelming care process for children and their parents; and 2) pediatric physiotherapy services play an important role in the transition to adulthood.…”

Defining mild, moderate, and severe pain in young people with physical disabilities

“…These include medications (e.g., 31–32), cognitive-behavioral therapy (e.g., 33–34), relaxation (e.g., 35–36), hypnosis (e.g., 37–38) and physical therapy (e.g., 39–40). The current findings suggest that it would be reasonable to discuss such treatments with patients when the young person reports his or her pain as having an intensity of 3 or greater, but that such discussions would be especially important to have when the young person reports his or her pain as having an intensity of 5 or more (out of 10).…”