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Rehabilitation techniques to improve lower limb function for children with bilateral spastic cerebral palsy: a
Huijuan Lin1, Xiaoying Zhang1, Tingting Chen2
1Department of Rehabilitation, Guangzhou Women and Children's Medical Centre, Guangzhou Medical University, Guangzhou, Guangdong, China; Department of Sports and Health, Guangzhou Sport University, Guangzhou, Guangdong, China.
Insights
Rehabilitation techniques like functional mobility training and treadmill training significantly improve lower limb function in children with bilateral spastic cerebral palsy (BSCP). Ankle foot orthosis also enhances balance and walking in affected children.
Area of Science:
- Pediatric Rehabilitation
- Neuroscience
- Biomedical Engineering
Background:
- Bilateral spastic cerebral palsy (BSCP) significantly impacts lower limb function in children.
- Effective rehabilitation strategies are crucial for improving mobility and participation in daily activities.
- The International Classification of Functioning, Disability, and Health-Children & Youth (ICF-CY) provides a framework for assessing function.
Purpose of the Study:
- To systematically review and meta-analyze the efficacy of various rehabilitation techniques for improving lower limb function in children with BSCP.
- To identify which interventions are most effective for specific functional outcomes based on the ICF-CY.
- To provide evidence-based recommendations for clinical practice.
Main Methods:
- Systematic review and meta-analysis of controlled trials.
- Searched five major databases (PubMed, Embase, Web of Science, ProQuest, Scopus) up to March 2025.
- Included 55 trials with 1501 children (aged ≥3 years) with BSCP.
Main Results:
- Functional mobility training (e.g., action observation) improved sitting, crawling, and kneeling.
- Treadmill training enhanced walking ability and velocity.
- Ankle foot orthosis improved dynamic balance and ankle dorsiflexion range; prolonged use increased stride length, cadence, and velocity.
Conclusions:
- Various rehabilitation techniques offer significant benefits for lower limb function in children with BSCP.
- Functional mobility training, treadmill training, and ankle foot orthosis are effective interventions.
- Findings can guide the selection of rehabilitation strategies for pediatric lower limb dysfunction.
Abstract:
This systematic review and meta-analysis pooled the efficacy of rehabilitation techniques on lower limb function in children with bilateral spastic cerebral palsy (BSCP) based on the International Classification of Functioning, Disability, and Health-Children & Youth version. Controlled trials written in English were searched in five databases (PubMed, Embase, Web of Science, ProQuest, Scopus) from inception to March 2025. PROSPERO registration: CRD 42024510104. A total of 55 trials involving 1501 children with BSCP, aged 3 years and above, were included in the meta-analysis. The rehabilitation techniques analyzed were treadmill training, functional mobility training, strength training, orthosis, non-invasive electrical stimulation, vibration, and home-based exercise programs. Most of the included trials targeted problems on gait parameters, kinematics parameters, and gross motor function for activities and participation. Meta-analysis showed that functional mobility training, such as action observation training, improved sitting, crawling and kneeling in children with BSCP; treadmill training, like platform swing walkway, mainly improved walking ability and velocity; ankle foot orthosis improved dynamic balance and range of ankle dorsiflexion during walking cycle. Subgroup analysis showed that ankle foot orthosis improved stride length within the first month of initial use and elevated walking cadence and velocity after three months of continuous use. Our findings may provide a reference for rehabilitation strategies on lower limb dysfunction in children with BSCP.
