Occupational therapy for children with cerebral palsy: a systematic review

Abstract

Objective: Occupational therapy (OT) for cerebral palsy focuses on the development of skills necessary for the performance of activities of daily living. The aim of this systematic review was to determine whether OT interventions improve outcome for children with cerebral palsy (CP). Methods: An extensive search in MEDLINE, CINAHL, EMBASE, AMED and SCISEARCH was performed. Studies with controlled and uncontrolled designs were included. Six intervention categories were distinguished and individually analysed using a best-evidence synthesis. This synthesis is based on the type of design, the methodological quality, the type of outcome measures and the statistical signi cance of the ndings. Results: Seventeen studies were included in this review, seven of which were randomized controlled trials (RCTs). One RCT had a high methodological quality. The analyses resulted in insuf cient evidence of the ef cacy of occupational therapy in all intervention categories, due to the low methodological quality of studies presenting statistically nonsigni cant results. Conclusion: Despite the reasonable number of studies identi ed, the inconclusive ndings regarding the ef cacy of occupational therapy for children with cerebral palsy may be a re ection of the dif culties in ef cacy research in OT for children with CP. Future research should critically re ect on methodological issues.

Evidence of the efficacy of occupational therapy in different conditions: an overview of systematic reviews

“…The independence of the assessors could not be guaranteed, as we included five reviews from our own research group. However, eight of the 14 reviews included were Cochrane reviews or used the same methodology as Cochrane eviews7 11 12,14,16,[18][19][20] and others were included in DARE in the Cochrane Library. Since the Cochrane Collaboration sets the standards for high quality research synthesis, we believe we have included mainly valid systematic reviews.…”

Low-dose/high-concentration localized botulinum toxin A improves upper limb movement and function in children with hemiplegic cerebral palsy

“…Individualized home programmes were developed with the family to implement in goal-relevant contexts of home or school/pre-school. Programmes drew on a suite of interventions offered by the therapist but driven by the family, including functional training, strengthening, splinting, casting, and motor learning (Copley and Kuipers 1999, Wilton 2003, Steultjens et al 2004. Standard indicators were used to verify the need for and to prescribe splinting and casting (Copley and Kuipers 1999).…”

Repeat injection of botulinum toxin A is safe and effective for upper limb movement and function in children with cerebral palsy

“…11 The home programmes in the extension study drew on the same suite of evidence-based interventions as the 6-month trial: functional training, splinting, casting, strengthening, and motor learning. 14 The repeat BTX-A injections were administered using the same dual localization technique, dosage concentrations, sedation, and analgesia previously reported for the 6-month trial. 9 Details for the 6-month injection were: mean total number of units per kg was 7.6 (SD 0.52; min 5.5, max 8.0) with the number of units per muscle per kg per injection being 1.5 (SD 0.21; min 0.5, max 1.9).…”

“…[11][12][13] Occupational therapy aims to maximize movement and function gains using the techniques of goal-focused functional training, strengthening, splinting, casting, and motor training. 4,14 Repeat BTX-A injections are typically required 10 because the drug's effect on nerve terminals lasts only about 12 to 16 weeks. 3 There is emerging evidence that therapy following BTX-A may enhance the functional outcomes beyond the pharmacologically effective period.…”