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The effects of hydrotherapy on athletic ability in children with cerebral palsy: A systematic review and
Ye Tao1, Ziyi Cao1, Min-Chul Shin1
1Department of Physical Education, Sejong University, Seoul, South Korea.
Insights
Hydrotherapy significantly improves gross motor functions in children with cerebral palsy (CP), especially with longer treatment durations. While fine motor skills may also benefit, effects on balance and muscle tone were not significant.
Area of Science:
- Physical Therapy
- Pediatric Rehabilitation
- Neurology
Background:
- Cerebral palsy (CP) is a non-progressive condition affecting movement and posture, often treated with physical therapies like hydrotherapy.
- Hydrotherapy is widely used for children with CP, but its comparative effectiveness and optimal application remain debated.
Purpose of the Study:
- To systematically evaluate the impact of hydrotherapy on gross and fine motor functions, balance, and muscle tone in pediatric cerebral palsy patients.
- To assess hydrotherapy's efficacy across different age groups and treatment durations.
Main Methods:
- A meta-analysis of randomized controlled trials (RCTs) was conducted, searching multiple databases for relevant studies.
- Included RCTs focused on hydrotherapy interventions for children and adolescents with CP.
- Study quality was assessed using the Cochrane risk of bias tool, and outcomes were analyzed using standardized mean differences (SMD).
Main Results:
- Hydrotherapy significantly improved gross motor functions (SMD=0.41) in children with CP, with consistent benefits in both younger (≤6 years) and older (>6 years) age groups.
- Interventions longer than 10 weeks showed significant gross motor improvements (SMD=0.48), unlike shorter programs.
- A positive trend was observed for fine motor functions (SMD=0.78), but no significant effects were found for balance or muscle tone.
Conclusions:
- Hydrotherapy is more effective than conventional care for enhancing gross motor function in children with CP, particularly with longer treatment durations.
- The benefits extend across different age groups, suggesting hydrotherapy's broad applicability.
- While promising for fine motor skills, hydrotherapy's impact on balance and muscle tone requires further investigation.
Background:
Cerebral palsy (CP) is a disability caused by brain malformations or injuries occurring from conception to infancy. Hydrotherapy is a popular treatment for children with cerebral palsy and other neuromotor disorders. Despite evidence supporting the efficacy of hydrotherapy for treating children with cerebral palsy, there remains controversy regarding its effectiveness over different follow-up periods and in comparison with other physical therapy methods.
Objective:
To compare the effects of hydrotherapy on gross motor abilities, fine motor functions, balance, and muscle tone in children and adolescents with cerebral palsy, and to assess evaluate efficacy across different age stages and treatment durations.
Methods:
This meta-analysis was registered with PROSPERO (registration number CRD42024535838). Literature searches were conducted in databases including CNKI, VIP, WanFang, Web of Science, PubMed, Embase, and the Cochrane Library starting from June 2024. Randomized controlled trials (RCTs) that assessed the effects of hydrotherapy on gross motor functions, fine motor functions, balance, and muscle tone in children and adolescents with cerebral palsy were included. RCTs were evaluated for quality using the Cochrane risk of bias tool. Outcomes were analyzed by calculating mean difference (MD) or standardized mean difference (SMD) along with their 95% confidence intervals (CIs).
Results:
Sixteen studies were included, assessing the impact of hydrotherapy compared to conventional care on gross motor functions in children and adolescents with cerebral palsy. The findings indicated that hydrotherapy significantly improved gross motor functions [SMD = 0.41, 95% CI = 0.15-0.68, I2 = 59.5%, p < 0.05], with consistent effects observed in children aged ≤6 years [SMD = 0.42, 95% CI = 0.16-0.68, I2 = 38.2%, p < 0.05] and those aged >6 years [SMD = 0.43, 95% CI = 0.22-0.63, I2 = 59.5%, p < 0.05]. Subgroup analysis based on intervention duration revealed that programs lasting more than 10 weeks were associated with significant improvements [SMD = 0.48, 95% CI = 0.31-0.66, I2 = 65.1%, p < 0.05], whereas no significant effects were found in interventions lasting 10 weeks or less [SMD = 0.14, 95% CI = -0.26-0.53, I2 = 35.6%, p > 0.05]. Hydrotherapy demonstrated a certain positive effect on fine motor functions [SMD = 0.78, 95% CI = 0.46-1.10, I2 = 46.4%, p > 0.05].In contrast, no statistically significant improvements were observed in balance [SMD = 0.64, 95% CI = -0.05-1.34, I2 = 80.7%, p > 0.05] or muscle tone [SMD = -0.45, 95% CI = -0.98-0.07, I2 = 58.2%, p > 0.05].
Conclusion:
The results indicate that hydrotherapy is more effective than conventional treatment in improving gross motor functions in children and adolescents with cerebral palsy, with consistent benefits observed across different age groups and in interventions of longer duration. Hydrotherapy also showed a positive trend in enhancing fine motor functions, although no significant improvements were observed in balance or muscle tone.
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