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Exercise interventions improve postural control in children with cerebral palsy: a systematic review
Rosalee Dewar1, Sarah Love2, Leanne Marie Johnston1
1The University of Queensland, Brisbane, Qld, Australia.
Insights
Exercise interventions show promise for improving postural control in children with cerebral palsy (CP). Moderate evidence supports gross motor training, hippotherapy, and treadmill training without body weight support.
Area of Science:
- Pediatric Rehabilitation
- Neurology
- Physical Therapy
Background:
- Postural control is a significant challenge for children with cerebral palsy (CP).
- Exercise interventions are increasingly utilized to address motor deficits in CP.
- Evidence for the effectiveness of various interventions is evolving.
Purpose of the Study:
- To systematically review exercise interventions aimed at enhancing postural control in children with CP.
- To evaluate the efficacy and effectiveness based on the level of evidence.
Main Methods:
- A systematic review adhering to AACPDM and PRISMA guidelines.
- Searched six databases for studies on CP, postural control, and exercise interventions.
- Assessed articles for evidence level and methodological quality.
Main Results:
- Identified 13 exercise interventions for postural control in children with CP.
- Moderate evidence supports gross motor task training, hippotherapy, treadmill training (no-BWS), trunk-targeted training, and reactive balance training.
- Weak or conflicting evidence exists for FES, hippotherapy simulators, NDT, treadmill training (BWS), virtual reality, and visual biofeedback. Progressive resistance exercise was ineffective.
Conclusions:
- Exercise-based treatments for improving postural control in children with CP have gained prominence.
- Enhanced study designs are clarifying treatment efficacy.
- Further research is needed to link impairments, treatments, and outcomes, exploring engaging and accessible interventions.
Aim:
The aim of this study was to evaluate the efficacy and effectiveness of exercise interventions that may improve postural control in children with cerebral palsy (CP).
Method:
A systematic review was performed using American Academy of Cerebral Palsy and Developmental Medicine (AACPDM) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology. Six databases were searched using the following keywords: ('cerebral palsy' OR 'brain injury'); AND ('postur*' OR 'balance' OR 'postural balance' [MeSH]); AND ('intervention' OR 'therapy' OR 'exercise' OR 'treatment'). Articles were evaluated based on their level of evidence and conduct.
Results:
Searches yielded 45 studies reporting 13 exercise interventions with postural control outcomes for children with CP. Five interventions were supported by a moderate level of evidence: gross motor task training, hippotherapy, treadmill training with no body weight support (no-BWS), trunk-targeted training, and reactive balance training. Six of the interventions had weak or conflicting evidence: functional electrical stimulation (FES), hippotherapy simulators, neurodevelopmental therapy (NDT), treadmill training with body weight support, virtual reality, and visual biofeedback. Progressive resistance exercise was an ineffective intervention, and upper limb interventions lacked high-level evidence.
Interpretation:
The use of exercise-based treatments to improve postural control in children with CP has increased significantly in the last decade. Improved study design provides more clarity regarding broad treatment efficacy. Research is required to establish links between postural control impairments, treatment options, and outcome measures. Low-burden, low-cost, child-engaging, and mainstream interventions also need to be explored.
