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Intensive training of motor function and functional skills among young children with cerebral palsy: a systematic
Hilde Tinderholt Myrhaug1,2, Sigrid Østensjø3, Lillebeth Larun4
1Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, St. Olavs plass, Postbox 4, 0130, Oslo, Norway. hitimy@hioa.no.
Insights
Intensive training for young children with cerebral palsy (CP) shows varied effects, with constraint-induced movement therapy (CIMT) demonstrating effectiveness for hand function. More research is needed on intensive gross motor training.
Area of Science:
- Pediatric rehabilitation
- Neuroscience
- Physical therapy
Background:
- Young children with cerebral palsy (CP) require interventions to address activity limitations and participation restrictions.
- Identifying optimal intensity for intensive interventions in CP is challenging.
- This systematic review aimed to categorize and summarize intensive motor and functional skills training for young children with CP.
Purpose of the Study:
- To describe and categorize intensive motor function and functional skills training in young children with CP.
- To summarize the effects of these intensive interventions.
- To examine factors influencing intervention effectiveness variations.
Main Methods:
- Systematic review of controlled studies involving young children (mean age <7 years) with CP.
- Studies assessed intensive motor function and functional skills training effects.
- Risk of bias assessment and categorization by intensity/context; meta-analyses performed.
Main Results:
- Thirty-eight studies were included; studies on gross motor function were fewer and older than those on hand function.
- Home-based training was common for hand function, increasing training volume but reducing controllability.
- Meta-analyses supported constraint-induced movement therapy (CIMT) for hand function; most studies showed similar improvements between intensive and conventional therapies.
Conclusions:
- Variations in training type, intensity, and context may explain differing outcomes for gross vs. fine motor function.
- Home training increases volume but poses control challenges, potentially affecting CIMT effectiveness.
- Further rigorous research on intensive gross motor training for CP is essential.
Background:
Young children with cerebral palsy (CP) receive a variety of interventions to prevent and/or reduce activity limitations and participation restrictions. Some of these interventions are intensive, and it is a challenge to identify the optimal intensity. Therefore, the objective of this systematic review was to describe and categorise intensive motor function and functional skills training among young children with CP, to summarise the effects of these interventions, and to examine characteristics that may contribute to explain the variations in these effects.
Methods:
Ten databases were searched for controlled studies that included young children (mean age less than seven years old) with CP and assessments of the effects of intensive motor function and functional skills training. The studies were critically assessed by the Risk of bias tool (RoB) and categorised for intensity and contexts of interventions. Standardised mean difference were computed for outcomes, and summarised descriptively or in meta-analyses.
Results:
Thirty-eight studies were included. Studies that targeted gross motor function were fewer, older and with lower frequency of training sessions over longer training periods than studies that targeted hand function. Home training was most common in studies on hand function and functional skills, and often increased the amount of training. The effects of constraint induced movement therapy (CIMT) on hand function and functional skills were summarised in six meta-analyses, which supported the existing evidence of CIMT. In a majority of the included studies, equal improvements were identified between intensive intervention and conventional therapy or between two different intensive interventions.
Conclusions:
Different types of training, different intensities and different contexts between studies that targeted gross and fine motor function might explain some of the observed effect variations. Home training may increase the amount of training, but are less controllable. These factors may have contributed to the observed variations in the effectiveness of CIMT. Rigorous research on intensive gross motor training is needed.
Systematic Review Registration Number:
CRD42013004023.
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