Interventions to improve upper limb function for children with bilateral cerebral palsy: a systematic review

Abstract

AimTo systematically review the efficacy of interventions on upper limb function in children 0 to 19 years of age with bilateral cerebral palsy on the basis of outcome measures of upper limb function and measures of activities and/or participation according to the International Classification of Functioning, Disability and Health.MethodCochrane, PubMed, Embase, CINAHL, and Web of Science were searched from inception to September 2017. Methodological quality and strength of evidence were analysed by two independent raters using Sackett's level of evidence and the American Academy for Cerebral Palsy and Developmental Medicine (AACPDM) guidelines.ResultsFifteen studies with a large variety of interventions and heterogeneity in outcome measures met the inclusion criteria. Twelve studies provided level IV evidence according to AACPDM guidelines. For three small randomized controlled trials the level of evidence was II. Only one of these trials showed strong methodological quality: a study on hand–arm bimanual intensive therapy including lower extremities.InterpretationWe identified a large variety of interventions, heterogeneity in outcome measures, and generally weak to moderate methodological quality for most studies. We recommend further research specifically aimed at bimanual‐intensive, goal‐directed, and task‐specific training programmes for the upper limb in children with bilateral cerebral palsy, using either high‐quality (multicentre) trials or well‐designed single‐case trials.What this paper adds There is a large variety of interventions on upper limb function in children with bilateral cerebral palsy.Heterogeneity of outcome measures and interventions impeded firm conclusions about intervention efficacy.Most studies had low‐level evidence and weak to moderate methodological quality.The strongest evidence from a small randomized controlled trial was for hand–arm bimanual intensive therapy including lower extremities.

State of the Evidence Traffic Lights 2019: Systematic Review of Interventions for Preventing and Treating Children with Cerebral Palsy

“…There are also several adjunctive interventions that when combined with task-specific motor training may augment the positive effects of training. These include electrical stimulation [65,[92][93][94], hydrotherapy [108,110,111], taping [159][160][161][162][163][164], transcranial direct current stimulation [101,[166][167][168], and virtual reality serious gaming [33][34][35][36][37][38][39][40][41][42][43][44][45][46][47] (yellow lights, weak positive). These interventions warrant more research as children reported finding gaming interventions rewarding and normalizing, and preferred electrical stimulation to wearing ankle-foot orthoses from a comfort perspective [93].…”

Effectiveness of Hand-Arm Bimanual Intensive Therapy on Hand Function among Children with Unilateral Spastic Cerebral Palsy: A Meta-Analysis

“…Primary and secondary impairments contributing to reduced development of the reach for, grip, and manipulation of objects affect self-care activities, such as drinking, feeding, grooming, dressing, and writing [6]. These impairments and functional limitations can affect the child's education, often leading to participation restriction [7].…”

Profile of motor abilities of children with cerebral palsy as a predictor of their functional independence in self-care and mobility

“…The aforementioned associated and accompanying disorders in the clinical picture of CP have an additional or aggravating effect on the developmental capacity of the child to learn and perform everyday tasks. Consequently, the improvement of functional abilities and the gradual increase of independence in activities of everyday life is undoubtedly one of the key goals of their rehabilitation [6,7].…”

“…The characteristics of mobility and self-care, including the independence level, are usually examined only in relation to gross motor abilities or in relation to gross motor and fine manual abilities [5,[8][9][10][11][12]. Besides, the effects of different types of treatment were examined and the factors influencing the development of functional independence in children with CP identified [6,7,13,14]. In other words, DOI: https://doi.org/10.2298/SARH190321077M previous empirical research did not take into account the overall profile of motor abilities of children with CP that, in addition to both gross motor function and manual abilities, includes bimanual fine motor function.…”