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Efficacy of upper limb therapies for unilateral cerebral palsy: a meta-analysis
Leanne Sakzewski1, Jenny Ziviani, Roslyn N Boyd
1BOcc Thy, Queensland Cerebral Palsy and Rehabilitation Research Centre, Level 7, Block 6, Royal Brisbane Hospital, Herston Rd, Herston QLD 4029, Australia. l.sakzewski1@uq.edu.au.
Insights
Intensive, goal-directed therapies like constraint-induced movement therapy improve upper limb function in children with unilateral cerebral palsy. Occupational therapy home programs also effectively supplement direct therapy for better outcomes.
Area of Science:
- Pediatric Rehabilitation
- Neuroscience
- Occupational Therapy
Background:
- Unilateral cerebral palsy (UCP) significantly impairs upper limb (UL) function in children, impacting daily independence and quality of life.
- Effective rehabilitation strategies are crucial for improving UL function in this population.
Purpose of the Study:
- To systematically review the efficacy of various nonsurgical upper limb therapies for children diagnosed with unilateral cerebral palsy.
Main Methods:
- A comprehensive literature search was conducted across major databases (Medline, CINAHL, Embase, Cochrane, PubMed) up to December 2012.
- Included studies were randomized controlled trials or comparison trials evaluating upper limb therapies.
Main Results:
- Forty-two studies involving 1454 subjects assessed 113 UL therapy approaches.
- Botulinum toxin A injections and occupational therapy (OT) showed moderate to strong effects on UL function compared to OT alone.
- Constraint-induced movement therapy (CIMT) demonstrated modest to strong effects on movement quality and efficiency compared to usual care.
Conclusions:
- Intensive, activity-based, goal-directed interventions such as CIMT and bimanual training show modest evidence of superior effectiveness over standard care.
- Occupational therapy (OT) home programs provide strong evidence of efficacy and can supplement direct therapy to increase intervention dosage.
- Current evidence suggests newer interventions like action observation and mirror therapy are still experimental.
Background And Objective:
Children with unilateral cerebral palsy present with impaired upper limb (UL) function affecting independence, participation, and quality of life and require effective rehabilitation. This study aims to systematically review the efficacy of nonsurgical upper limb therapies for children with unilateral cerebral palsy.
Methods:
Medline, CINAHL (Cumulative Index to Nursing and Allied Health Literature), Embase, the Cochrane Central Register of Controlled Trials, and PubMed were searched to December 2012. Randomized controlled or comparison trials were included.
Results:
Forty-two studies evaluating 113 UL therapy approaches (N = 1454 subjects) met the inclusion criteria. Moderate to strong effects favoring intramuscular injections of botulinum toxin A and occupational therapy (OT) to improve UL and individualized outcomes compared with OT alone were identified. Constraint-induced movement therapy achieved modest to strong treatment effects on improving movement quality and efficiency of the impaired UL compared with usual care. There were weak treatment effects for most outcomes when constraint therapy was compared with an equal dose (amount) of bimanual OT; both yielded similar improved outcomes. Newer interventions such as action observation training and mirror therapy should be viewed as experimental.
Conclusions:
There is modest evidence that intensive activity-based, goal-directed interventions (eg, constraint-induced movement therapy, bimanual training) are more effective than standard care in improving UL and individualized outcomes. There is little evidence to support block therapy alone as the dose of intervention is unlikely to be sufficient to lead to sustained changes in UL outcomes. There is strong evidence that goal-directed OT home programs are effective and could supplement hands-on direct therapy to achieve increased dose of intervention.
