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A Systematic Review of Training Methods That May Improve Selective Voluntary Motor Control in Children With Spastic
Annina Fahr1,2,3, Jeffrey W Keller1,2,4, Hubertus J A van Hedel1,2
1Swiss Children's Rehab, University Children's Hospital Zurich, Affoltern am Albis, Switzerland.
Insights
This review found conflicting evidence for therapies like constraint-induced movement therapy (CIMT) and robot-assisted therapy in improving selective motor control in children with cerebral palsy. More targeted research is needed to identify effective interventions.
Area of Science:
- Neurology
- Pediatrics
- Rehabilitation Medicine
Background:
- Impaired selective voluntary motor control, a hallmark of upper motor neuron lesions, significantly impacts children and youths with spastic cerebral palsy.
- This condition affects the ability to isolate muscle activation for voluntary movements and postures.
Approach:
- A systematic review and best evidence synthesis was conducted.
- Six major databases were searched, and 23 controlled studies were included after rigorous screening.
- Methodological quality and risk of bias were independently assessed by two reviewers.
Key Points:
- Interventions reviewed included constraint-induced movement therapy (CIMT), electrical stimulation, robot-assisted therapy, and functional training.
- Conflicting evidence emerged for CIMT, robot-assisted rehabilitation, and mirror therapy concerning upper extremity function.
- Significant heterogeneity among studies complicates definitive conclusions.
Conclusions:
- Current evidence is insufficient to recommend specific interventions for improving selective motor control in pediatric cerebral palsy.
- Further high-quality studies focusing on selective motor control as a primary outcome are essential.
- Future research should address the heterogeneity observed in intervention and outcome measures.
Abstract:
Background: Impaired selective voluntary motor control is defined as "the reduced ability to isolate the activation of muscles in response to demands of a voluntary posture or movement." It is a negative motor sign of an upper motor neuron lesion. Objective: This paper reviews interventions that may improve selective motor control in children and youths with spastic cerebral palsy. The aim was to systematically evaluate the methodological quality and formulate the level of evidence from controlled studies. Methods: Six databases (Scopus, Web of Science, PubMed, Embase, MEDLINE, and CINAHL) were searched with predefined search terms for population, interventions, and outcomes. Two reviewers independently completed study selection and ratings of methodological quality and risk of bias. Evidence was summarized in a best evidence synthesis. Results: Twenty-three studies from initially 2,634 papers were included. The interventions showed a wide variety of approaches, such as constraint-induced movement therapy (CIMT), electrical stimulation, robot-assisted therapy, and functional training. The evidence synthesis revealed conflicting evidence for CIMT, robot-assisted rehabilitation and mirror therapy for the upper extremities in children with cerebral palsy. Conclusions: Final recommendations are difficult due to heterogeneity of the reviewed studies. Studies that include both an intervention and an outcome that specifically focus on selective voluntary motor control are needed to determine the most effective therapy.
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