Interventions to improve upper limb function for children with bilateral cerebral palsy: a systematic review

Area of Science:

• Pediatric Rehabilitation
• Neurology
• Physical Therapy

Background:

• Bilateral cerebral palsy significantly impacts upper limb function in children.
• Effective interventions are crucial for improving daily activities and participation.

Purpose of the Study:

• To systematically review the efficacy of interventions for upper limb function in children (0-19 years) with bilateral cerebral palsy.
• To analyze outcomes based on upper limb function, activities, and participation using the International Classification of Functioning, Disability and Health (ICF).

Main Methods:

• Searched multiple databases (Cochrane, PubMed, Embase, CINAHL, Web of Science) from inception to September 2017.
• Assessed methodological quality and strength of evidence using Sackett's level of evidence and AACPDM guidelines by two independent raters.

Main Results:

• Fifteen studies met inclusion criteria, featuring diverse interventions and outcome measures.
• Twelve studies provided Level IV evidence; three small randomized controlled trials (RCTs) had Level II evidence.
• One RCT on hand-arm bimanual intensive therapy (including lower extremities) showed strong methodological quality.

Conclusions:

• A wide array of interventions exist, but heterogeneity in methods and outcomes limits firm conclusions on efficacy.
• Most studies exhibited low-level evidence and weak to moderate methodological quality.
• Further high-quality research is recommended for bimanual-intensive, goal-directed, and task-specific upper limb training programs in this population.