Task-specific gross motor skills training for ambulant school-aged children with cerebral palsy: a systematic review

Abstract

ObjectivesThe primary objective is to systematically evaluate the evidence for the effectiveness of task-specific training (TST) of gross motor skills for improving activity and/or participation outcomes in ambulant school-aged children with cerebral palsy (CP). The secondary objective is to identify motor learning strategies reported within TST and assess relationship to outcome.DesignSystematic review.MethodRelevant databases were searched for studies including: children with CP (mean age >4 years and >60% of the sample ambulant); TST targeting gross motor skills and activity (skill performance, gross motor function and functional skills) and/or participation-related outcomes. Quality of included studies was assessed using standardised tools for risk of bias, study design and quality of evidence across outcomes. Continuous data were summarised for each study using standardised mean difference (SMD) and 95% CIs.ResultsThirteen studies met inclusion criteria: eight randomised controlled trials (RCTs), three comparative studies, one repeated-measures study and one single-subject design study. Risk of bias was moderate across studies. Components of TST varied and were often poorly reported. Within-group effects of TST were positive across all outcomes of interest in 11 studies. In RCTs, between-group effects were conflicting for skill performance and functional skills, positive for participation-related outcomes (one study: Life-HABITS performance SMD=1.19, 95% CI 0.3 to 2.07, p<0.001; Life-HABITS satisfaction SMD=1.29, 95% CI 0.40 to 2.18, p=0.001), while no difference or negative effects were found for gross motor function. The quality of evidence was low-to-moderate overall. Variability and poor reporting of motor learning strategies limited assessment of relationship to outcome.ConclusionsLimited evidence for TST for gross motor skills in ambulant children with CP exists for improving activity and participation-related outcomes and recommendations for use over other interventions are limited by poor study methodology and heterogeneous interventions.RegistrationPROSPERO ID42016036727

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

“…This decline in severity is encouraging. Children with cerebral palsy may be more likely than ever to be treatment responsive to motor [20,21], bimanual training [54][55][56], constraintinduced movement therapy [46,[62][63][64][65][66][67], functional chewing training [137], goal-directed training [98], home programs using goal-directed training [112], mobility training [123,127], treadmill training [65,123,127], partial body weight support treadmill training [123,127,169], and occupational therapy post botulinum toxin [190] (green lights). Moreover, environmental enrichment to promote task performance is effective (green light) [95] and adapting the environment and task to enable task performance via context-focused therapy (yellow light) [77] is a potent modulator of effective care.…”

“…However, it is very important to recognize that for some families, the process and routine of donning a suit may mean they engage in more intensive therapies and active practice, which may produce positive results. We know that intensive task-specific motor practice is effective and works in a variety of treatment modalities [98]. The theory behind transcranial direct current stimulation having an augmentative effect to motor training, through provision of an additional targeted stimulation of the motor cortex, is logical, and more research is warranted [166][167][168].…”

Movement‐based interventions for preschool‐age children with, or at risk of, motor impairment: a systematic review

“…However, clinicians are encouraged to consider participation when providing therapy for children with motor impairment; thus the scarcity of interventions assessing participation at preschool age represents a concerning gap in the literature. This was not an unexpected finding; previous systematic reviews have commented that participation outcomes are rarely used for children with motor impairment . Participation is an important rehabilitation goal, and there is minimal evidence to suggest participation is an inevitable consequence of interventions targeted at the activity or body structure and function levels .…”

“…Previous systematic reviews considering task‐specific training and motor‐based interventions for children with DCD have reported similar findings in regards to small numbers of studies of heterogeneous quality and intervention type, and likewise found difficulties establishing definite conclusions. Movement‐based interventions with emerging efficacy for older children with motor impairment, such as task‐specific training or goal‐directed interventions based on motor‐learning principles, require further investigation to determine whether they are effective for children of preschool age. Similarly, early intervention, which improves motor outcomes for infants, may also be effective if implemented with children at preschool age.…”

“…This was not an unexpected finding; previous systematic reviews have commented that participation outcomes are rarely used for children with motor impairment. 21,[52][53][54] Participation is an important rehabilitation goal, and there is minimal evidence to suggest participation is an inevitable consequence of interventions targeted at the activity or body structure and function levels. 21,55,56 Interventions that target and assess participation are therefore needed for preschool-age children with motor impairment to support therapy providers and families in clinical decision making.…”