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A systematic review of common physiotherapy interventions in school-aged children with cerebral palsy
Liz Martin1, Richard Baker, Adrienne Harvey
1Yooralla, Belmore School, Balwyn, Australia. liz.martin@yooralla.com.au
Insights
This review found that strength and functional training show promising results for children with cerebral palsy (CP). More high-level evidence is needed for other physiotherapy interventions like weight-supported treadmill training and neurodevelopmental treatment.
Area of Science:
- Pediatric Rehabilitation
- Neurology
- Evidence-Based Practice
Background:
- Cerebral palsy (CP) is a common childhood neurological disorder affecting movement and posture.
- Conventional physiotherapy interventions are widely used to manage CP symptoms in children.
- Evaluating the evidence base for these interventions is crucial for optimizing treatment strategies.
Purpose of the Study:
- To systematically review and critically appraise the evidence for common physiotherapy interventions in children with CP (aged 4-18 years).
- To assess the quality of evidence using the Oxford Centre for Evidence-Based Medicine Levels of Evidence.
- To identify gaps in the research for optimizing CP management.
Main Methods:
- Systematic literature search yielding 34 articles.
- Inclusion and exclusion criteria applied to select relevant studies.
- Interventions reviewed: strength training, functional training, weight-supported treadmill training (WBSTT), and neurodevelopmental treatment (NDT).
- Analysis of treatment dosage and its impact on outcomes.
- Critical appraisal using the Oxford Centre for Evidence-Based Medicine Levels of Evidence.
Main Results:
- Strength training demonstrated significant improvements in muscle strength, with some evidence for functional gains.
- Functional training showed positive effects on gross motor function, endurance, and gait parameters.
- Weight-supported treadmill training (WBSTT) showed non-significant trends for improvement in Gross Motor Function Measure (GMFM) and gait velocity, based on low-level evidence.
- Neurodevelopmental treatment (NDT) showed significant improvements in GMFM in one high-level randomized controlled trial (RCT).
- High-level evidence on treatment dosage found no significant differences based on varying treatment intensities.
Conclusions:
- The evidence base for strength and functional training in school-aged children with CP has strengthened.
- Further high-level evidence is required for interventions such as WBSTT and NDT to confirm their efficacy.
- Optimizing physiotherapy for CP necessitates continued rigorous research and evidence synthesis.
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.
